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Pennsylvania rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Facilitymedian $4 · 10th–90th $2$40%20%40%10th90th$4Professionalmedian $3 · 10th–90th $2$50%20%40%10th90th$3$0.1$0.5$5.0$50.0$500.0$5.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $4.07 / $4.07
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $3.98
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.25 / $5.25 / $5.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.16 / $3.16 / $5.01
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.63 / $2.63 / $3.63
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.90 / $6.92 / $10.00
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.37 / $5.37 / $5.37
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.16 / $3.72 / $5.37
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $3.98
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $7.41 / $10.23
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.72 / $3.72 / $5.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.72 / $5.01 / $6.46
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.74 / $2.19 / $3.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $2.57 / $5.37