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Pennsylvania rates for HCPCS A4417

Ostomy Pouch Closed With Barrier Attached With Built-In Convexity With Filter (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $2.54 / $4.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $3.19 / $4.17
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
$3.97 / $5.21 / $5.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $6.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $3.68
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $5.21 / $9.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $2.54 / $4.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $3.18 / $4.55
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.40 / $7.40 / $10.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $6.11
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $6.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $4.96 / $4.96
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $4.96 / $4.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.60 / $4.55