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Virginia rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.33 / $2.33 / $2.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.33 / $2.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $2.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $2.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.84 / $3.78 / $4.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $2.52 / $4.34
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.84 / $4.97 / $6.30
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $3.00 / $5.37
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $3.00 / $5.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.88 / $2.70