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Pennsylvania rates for HCPCS A4377

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

Facilitymedian $4 · 10th–90th $2$60%20%40%10th90th$4Professionalmedian $3 · 10th–90th $2$60%20%40%10th90th$3$0.1$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$2.00 / $4.68 / $4.68
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $5.01
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
$6.03 / $6.03 / $6.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.63 / $3.63 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.09 / $3.09 / $3.72
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.62 / $7.94 / $11.48
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $6.17
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.63 / $4.27 / $6.17
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $5.01
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $8.51 / $11.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.27 / $4.27 / $12.88
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.27 / $5.75 / $12.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.04 / $2.51 / $3.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.09 / $3.02 / $6.17