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Louisiana 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
$5.66 / $6.98 / $6.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.66 / $6.98 / $7.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.59 / $14.68 / $20.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.86 / $7.01 / $7.01
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $6.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.93 / $6.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $4.59 / $6.45