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Iowa 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
$6.30 / $6.30 / $7.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.90 / $6.27 / $8.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $10.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.28 / $10.86 / $14.53
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.61 / $10.89 / $15.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.75 / $11.48 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.84 / $4.99 / $13.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.83 / $10.86 / $13.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.50 / $12.19 / $20.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.81 / $4.93 / $12.90
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.88 / $8.88 / $8.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $8.88 / $8.88