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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
$3.98 / $7.76 / $7.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.03 / $8.91
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $9.77 / $9.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $5.89 / $15.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $6.31
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $10.96 / $19.05
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $7.08 / $10.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.41
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $7.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.03 / $9.33
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $14.13 / $19.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $7.08 / $9.33
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.59 / $9.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $4.17 / $6.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $4.90 / $8.91