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Pennsylvania rates for HCPCS A4389

Ostomy Pouch Drainable With Barrier Attached With Built-In Convexity (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.26 / $4.26 / $6.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.64 / $5.32 / $6.76
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
$6.61 / $8.67 / $8.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $10.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $6.14
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.27 / $7.98 / $11.74
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.18 / $5.87 / $6.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.26 / $4.26 / $6.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $5.32 / $7.19
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.80 / $12.40 / $17.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $10.16
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $10.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.21 / $8.26 / $8.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.21 / $8.26 / $8.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $4.33 / $7.59