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Vermont rates for HCPCS A4389

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $5.01 / $6.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $5.25 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $5.37
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $8.51 / $8.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $3.39 / $3.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $6.46 / $18.20