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Pennsylvania rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.60 / $5.60 / $8.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.00 / $9.13
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
$8.69 / $11.42 / $11.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $13.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $5.83 / $8.07
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $10.51 / $15.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.60 / $5.60 / $8.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $7.00 / $10.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.20 / $16.30 / $22.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $13.38
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $5.83 / $13.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.17 / $10.87 / $10.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.17 / $10.87 / $10.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $5.69 / $9.97