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Virginia rates for HCPCS A4389

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $5.37 / $5.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $5.37 / $6.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $4.34 / $5.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.88 / $5.88 / $5.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $6.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $8.67 / $10.40
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $5.78 / $10.01
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $11.40 / $14.46
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.73 / $6.90 / $11.93
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $6.91 / $11.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.38 / $4.33 / $6.22