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Pennsylvania rates for HCPCS A4404

Ostomy Ring Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.37 / $1.78
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.23
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
$1.70 / $2.23 / $2.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $2.34 / $3.17
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.51
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.74
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.37 / $1.94
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $2.90 / $4.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.60
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $2.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.60 / $2.12 / $2.12
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.12 / $2.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $1.12 / $2.02