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Virginia rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.30 / $8.30 / $9.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.26 / $8.30 / $10.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $8.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.08 / $9.08 / $9.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.06 / $13.41 / $16.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $8.85 / $15.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $17.62 / $22.35
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.85 / $10.62 / $18.45
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.46 / $10.50 / $18.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.22 / $6.70 / $9.61