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Pennsylvania rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $4.47 / $7.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $5.59 / $7.28
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
$6.94 / $9.11 / $9.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $10.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $6.43
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.77 / $8.38 / $12.33
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $6.15 / $6.49
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $4.47 / $7.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $5.59 / $7.98
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.30 / $13.00 / $18.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $10.68
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $10.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.50 / $8.67 / $8.67
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $8.67 / $8.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $4.54 / $7.95