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California 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
$3.60 / $3.94 / $38.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.94 / $6.05 / $38.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.84 / $5.83 / $15.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $12.47
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.14 / $18.37 / $28.38
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.25 / $28.80 / $50.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.69 / $8.07 / $11.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.17
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.73 / $13.41 / $16.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.05 / $9.39 / $20.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.78 / $66.78 / $100.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.49 / $27.49 / $27.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $11.87 / $13.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $12.24
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.33 / $25.33 / $25.33
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.73 / $15.71 / $20.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.17 / $5.69 / $12.99