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Virginia rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.63 / $5.63 / $6.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.03 / $5.63 / $6.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $4.55 / $6.07
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.16 / $6.16 / $6.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $6.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $5.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.83 / $9.11 / $10.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $6.05 / $10.41
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $11.96 / $15.17
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $7.23 / $12.34
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $7.23 / $12.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.54 / $4.54 / $6.51