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Virginia rates for HCPCS A4416

Ostomy pouch, closed, with barrier attached, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $3.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $3.98
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $2.57 / $2.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $2.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.95 / $3.89 / $5.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.75 / $4.07
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $2.82 / $4.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.40 / $2.57
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.63 / $3.47 / $13.49
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $3.39 / $11.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.48 / $1.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.91 / $2.95