go back

Oregon 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
$20.83 / $20.83 / $20.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.94 / $9.84 / $38.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.39 / $24.14 / $29.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.61 / $11.76 / $13.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.98 / $12.07 / $13.41
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.04 / $13.10 / $14.75
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.73 / $13.41 / $13.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $11.75 / $14.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $11.75 / $14.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.53 / $14.75 / $14.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $5.69 / $10.85