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Maine rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.99 / $6.55 / $6.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $5.73 / $5.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $5.83 / $8.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.31 / $9.31 / $9.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.01 / $6.55 / $8.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.69 / $13.11