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Nebraska 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
$11.11 / $11.11 / $11.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.11 / $11.11 / $11.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.78 / $12.97 / $13.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $14.75 / $14.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.07 / $14.75 / $22.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.16 / $13.41 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.53 / $6.70 / $11.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.72 / $14.75 / $18.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.10 / $17.23 / $29.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.72 / $6.70 / $8.77