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Arkansas rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.81 / $10.81 / $10.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.79 / $10.81 / $10.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $8.52 / $8.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.03 / $17.03 / $17.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.41 / $13.41 / $13.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.41 / $13.41 / $13.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $9.49
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.63 / $8.63 / $8.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $6.05 / $8.07