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Illinois rates for HCPCS A4391

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

Facilitymedian $10 · 10th–90th $5$540%20%10th90th$10Professionalmedian $6 · 10th–90th $4$100%20%10th90th$6$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $10.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $6.03 / $10.00
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.46 / $6.46 / $6.46
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $26.92 / $85.11
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $7.41 / $7.41
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $10.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $10.96
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.32 / $14.13 / $18.62
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.47 / $4.47 / $4.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.69 / $3.80 / $10.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.47 / $4.90 / $8.13