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Virginia rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $3.22 / $3.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $3.22 / $3.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $3.46
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.52 / $3.52 / $3.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $3.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.91 / $5.21 / $6.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $3.43 / $5.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $6.84 / $8.68
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.43 / $4.11 / $7.13
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $4.11 / $7.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.60 / $3.72