go back

Indiana 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
$11.49 / $11.49 / $13.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $8.52 / $11.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.73 / $6.73 / $12.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $9.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.06 / $14.75 / $20.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.40 / $14.75 / $18.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $13.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $6.40 / $9.61