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Virginia rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.83 / $14.83 / $16.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.24 / $14.83 / $18.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.03 / $12.03 / $16.01
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.23 / $16.23 / $16.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $16.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $13.54 / $13.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $23.99 / $28.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.57 / $15.97 / $27.66
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $31.52 / $39.97
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.82 / $18.94 / $32.79
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.82 / $18.94 / $32.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $11.97 / $17.18