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Minnesota 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
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.94 / $10.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $15.85 / $22.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $13.49 / $13.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $50.12 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $17.38 / $19.50
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $48.98 / $95.50
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $16.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $13.49 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.75 / $14.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $5.13 / $5.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $6.31 / $15.49