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Vermont rates for HCPCS A4387

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
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 / $1.95
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $1.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $2.61 / $3.97