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Pennsylvania rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.84 / $4.84 / $7.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $6.06 / $7.90
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
$7.52 / $9.86 / $9.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $11.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $6.98
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.05 / $9.08 / $13.36
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.39 / $8.39 / $8.39
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.84 / $4.84 / $7.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $6.06 / $8.65
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.20 / $14.10 / $19.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $11.57
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $11.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.06 / $9.40 / $9.40
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.06 / $9.40 / $9.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.37 / $4.93 / $8.63