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Alaska rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.65 / $2.65 / $2.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.65 / $7.23
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $2.11 / $2.72
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.72 / $5.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $1.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $2.11 / $3.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.67