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Pennsylvania rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.77 / $11.77 / $18.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.35 / $14.71 / $19.19
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
$18.27 / $23.99 / $23.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $28.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $13.54 / $13.54
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.07 / $23.99 / $45.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.77 / $11.77 / $18.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.14 / $14.71 / $22.69
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.80 / $34.20 / $47.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $28.12
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $13.54 / $16.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.16 / $22.84 / $22.84
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.16 / $22.84 / $22.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $11.97 / $20.96