go back

Minnesota 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 / $6.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.32 / $6.30 / $7.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $10.55 / $13.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.90 / $9.57 / $9.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $30.00 / $83.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.63 / $12.32 / $14.76
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.80 / $28.79 / $65.61
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.60 / $11.63 / $11.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.78 / $9.86 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $4.45 / $9.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $4.66 / $9.92