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Montana rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Facilitymedian $13 · 10th–90th $8$160%20%10th90th$13Professionalmedian $11 · 10th–90th $5$180%10%10th90th$11$5.0$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.01
Median
$8.91
Typical High
$18.20
BCBS
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$13.18
Typical High
$13.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$14.13
Typical High
$14.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$14.13
Typical High
$14.13
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$13.18
Typical High
$25.70
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$13.18
Typical High
$25.70
Providence
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$12.59
Typical High
$16.22
Providence
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$14.13
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.13
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$5.75
Typical High
$7.76