go back

Pennsylvania rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.58 / $6.58 / $10.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.67 / $8.23 / $10.73
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.41 / $13.41 / $13.41
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
$10.22 / $13.41 / $13.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $15.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $12.34 / $18.16
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.06 / $9.39 / $10.06
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.58 / $6.58 / $10.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.08 / $8.23 / $11.75
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $19.10 / $26.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $15.72
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $15.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.60 / $12.77 / $12.77
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.60 / $12.77 / $12.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.70 / $12.11