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Pennsylvania rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, 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 / $1.44 / $1.53
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
$1.37 / $1.37 / $2.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.37
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.29 / $4.34
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
$0.84 / $1.48 / $1.79
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $3.30 / $4.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $2.62
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.66
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 / $2.00