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Pennsylvania rates for HCPCS A5063

Ostomy pouch, drainable; for use on barrier with flange (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.85 / $2.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $2.20 / $2.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $3.78 / $45.00
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
$2.88 / $3.78 / $3.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $4.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.48 / $5.12
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.70 / $3.78
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.85 / $2.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $2.16 / $2.88
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.65 / $891.65 / $891.65
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.20 / $5.20 / $7.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $4.43
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $4.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.71 / $3.60 / $3.60
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $3.60 / $3.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.88 / $3.41