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Pennsylvania rates for HCPCS A4415

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $4.09 / $6.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.91 / $5.13 / $6.69
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
$6.38 / $8.38 / $8.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $9.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $4.28 / $5.92
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.98 / $7.71 / $11.35
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.38 / $8.38 / $8.38
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $4.09 / $6.52
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.91 / $5.13 / $7.33
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.40 / $11.90 / $16.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $9.82
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $4.28 / $9.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.99 / $7.97 / $7.97
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.99 / $7.97 / $7.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.94 / $4.18 / $6.96