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Pennsylvania rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.93 / $2.93 / $4.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $3.67 / $4.79
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
$4.55 / $5.99 / $5.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $7.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.06 / $4.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.51 / $5.99 / $11.38
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.93 / $2.93 / $4.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $3.67 / $5.66
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $8.60 / $11.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $7.02
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.06 / $7.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.29 / $5.70 / $5.70
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.29 / $5.70 / $5.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.99 / $5.40