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Pennsylvania rates for HCPCS A4419

Ostomy pouch, closed; for use on barrier with nonlocking flange, with filter (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $1.18 / $1.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.48 / $1.92
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
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
$1.83 / $2.41 / $2.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.45 / $2.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $2.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $2.22 / $3.26
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.64 / $1.73
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $1.18 / $1.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $1.40 / $1.92
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.10 / $4.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.45 / $2.82
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $2.65
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $2.29 / $2.29
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.29 / $2.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.21 / $2.11