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Vermont rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $8.71 / $10.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $8.32
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $13.18 / $13.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $5.25 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $9.55 / $28.18