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Pennsylvania rates for HCPCS A4412

Ostomy Pouch Drainable High Output For Use On A Barrier With Flange (2 Piece System) Without Filter Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.85 / $2.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.31 / $3.02
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
$2.88 / $3.78 / $3.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $8.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.80
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.48 / $4.92 / $6.15
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.85 / $2.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $2.31 / $3.31
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.70 / $5.40 / $7.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $8.07
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $4.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.71 / $3.60 / $3.60
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $3.60 / $3.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.88 / $3.41