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Pennsylvania rates for HCPCS A4375

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

Facilitymedian $17 · 10th–90th $11$190%20%40%10th90th$17Professionalmedian $14 · 10th–90th $10$240%20%10th90th$14$0.2$2.0$20.0$200.0$2.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.96 / $18.62 / $18.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $14.13 / $21.88
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $23.99 / $23.99
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $15.85 / $25.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $13.49 / $13.49
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $32.36 / $46.77
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $16.98 / $24.55
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $10.96
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $14.13 / $20.89
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $33.88 / $46.77
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.47 / $16.98 / $22.91
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.72 / $16.98 / $69.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.13 / $10.00 / $15.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.51 / $12.02 / $25.12