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Pennsylvania rates for HCPCS A5055

Stoma Cap (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.97 / $0.97 / $1.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.17 / $1.52
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
$1.50 / $1.98 / $1.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $2.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $2.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.98 / $2.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.97 / $0.97 / $1.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.21 / $1.64
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $2.70 / $3.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $2.35
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $2.27
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.88 / $1.88
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.88 / $1.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.99 / $1.73