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Pennsylvania rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.54 / $1.54 / $2.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.09 / $1.93 / $2.50
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
$2.39 / $3.14 / $3.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $4.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.33
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $3.14 / $5.97
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.54 / $1.54 / $2.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $1.93 / $2.97
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $6.20 / $6.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $4.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $3.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.99 / $2.99 / $4.13
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.99 / $2.99 / $4.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.79 / $3.97