go back

California rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.65 / $2.90 / $28.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.90 / $4.45 / $28.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.56 / $4.29 / $11.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $4.95 / $9.18
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.40 / $13.51 / $20.87
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.34 / $21.20 / $37.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $8.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $6.83
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.90 / $9.86 / $11.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $6.91 / $15.30
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.15 / $49.15 / $74.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.23 / $20.23 / $20.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $8.73 / $9.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.93 / $9.01
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.63 / $18.63 / $18.63
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.90 / $11.56 / $15.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.79 / $4.19 / $9.69