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Nebraska rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.72 / $1.72 / $1.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.72 / $1.72 / $1.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $2.00 / $2.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $2.29 / $2.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.29 / $3.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $2.29 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $1.04 / $1.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $2.67 / $4.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $1.04 / $1.36