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Virginia rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.94 / $1.94 / $2.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.94 / $1.94 / $2.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.65 / $2.21
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $3.14 / $3.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.94 / $2.50 / $3.61
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $4.13 / $5.23
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.06 / $2.59 / $5.32
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $2.59 / $5.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $1.57 / $3.37