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Virginia rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.11 / $6.11 / $6.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $6.11 / $7.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $4.95 / $6.59
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.68 / $6.68 / $6.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $6.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $6.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $9.86 / $11.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $6.57 / $11.27
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $12.97 / $16.45
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.51 / $7.85 / $13.58
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.51 / $7.90 / $13.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.84 / $4.93 / $7.07