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Stoma Cap

Pennsylvania rates for HCPCS A5055

Stoma cap

Rates data updated October 2026.

How much does Stoma Cap cost?

$1.20

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $1.20 for this service. The price depends on where it is billed: about $1.20 from a physician practice, and about $1.29 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1.20$1.02 to $1.86
FacilityA hospital or hospital-owned outpatient department$1.29$1.20 to $7.24

How much rates vary

Facilitymedian $1 · 10th to 90th $1 to $13Professionalmedian $1 · 10th to 90th $1 to $2
$1$10$100$1K$10Kfacility $1professional $1

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$0.98
Median
$0.98
Typical High
$1.20
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.98
Median
$1.20
Typical High
$1.20
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.15
Median
$0.18
Typical High
$0.18
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.10
Median
$0.12
Typical High
$0.12
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$5,011.87
Typical High
$79,432.82
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$1.58
Median
$2.00
Typical High
$2.00
Cigna
Setting
Facility
Modifier
None
Typical Low
$1.20
Median
$1.20
Typical High
$1.29
Cigna
Setting
Professional
Modifier
None
Typical Low
$1.02
Median
$1.02
Typical High
$9.77
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$1.82
Median
$2.95
Typical High
$3.39
Geisinger
Setting
Facility
Modifier
None
Typical Low
$2.04
Median
$2.04
Typical High
$2.04
Geisinger
Setting
Professional
Modifier
None
Typical Low
$1.00
Median
$1.20
Typical High
$2.04
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$0.98
Median
$0.98
Typical High
$0.98
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$0.98
Median
$1.20
Typical High
$1.20
Martin's Point
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.15
Median
$0.18
Typical High
$0.18
Martin's Point
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.10
Median
$0.12
Typical High
$0.12
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$1.29
Median
$2.82
Typical High
$3.02
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$1.41
Median
$6.46
Typical High
$10.96
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$1.41
Median
$1.41
Typical High
$1.86
United
Setting
Professional
Modifier
None
Typical Low
$0.78
Median
$1.00
Typical High
$1.66

Where Pennsylvania sits

The same service costs 2.1 times more in Kansas than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 30th of 51

$1.20

KS $2.14KY $1.00

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.