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West 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
$7.40 / $7.40 / $7.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $8.23 / $9.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.72 / $16.76 / $23.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.72 / $9.39 / $16.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.53 / $15.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $64.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $6.70 / $11.16