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Pennsylvania rates for HCPCS A4367

Ostomy Belt Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.05 / $5.05 / $8.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.12 / $5.97 / $7.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.28 / $10.28 / $10.28
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.83 / $10.28 / $10.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.18 / $6.18 / $12.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $7.06
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.32 / $8.80 / $13.47
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.12 / $7.20 / $7.71
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.05 / $5.05 / $8.01
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $6.30 / $7.66
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $14.00 / $20.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.18 / $6.18 / $12.05
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $12.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.35 / $9.78 / $9.78
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.35 / $9.78 / $9.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.70 / $5.13 / $9.26