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Missouri 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
$5.75 / $9.36 / $13.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $7.53 / $14.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.05 / $8.05 / $8.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $11.05
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 / $6.86 / $8.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.24 / $12.07 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.72 / $6.70 / $10.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.70 / $9.92