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Maine 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
$5.86 / $7.70 / $7.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $6.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $10.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $7.16 / $9.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $10.95 / $10.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.06 / $7.70 / $10.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.70 / $15.40