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Arizona rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.11 / $8.05 / $11.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.39 / $9.39 / $9.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.54 / $12.80 / $23.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.86 / $11.81 / $16.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $9.61 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.53 / $5.69 / $8.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.49 / $5.69 / $8.17