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Vermont rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.64 / $8.52 / $8.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $7.21 / $8.03
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.03
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $7.59 / $8.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $7.68 / $14.60