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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
$5.01 / $7.94 / $26.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $9.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $10.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $9.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $14.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $8.91 / $26.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $5.13 / $5.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $7.08 / $12.02