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California rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.00 / $1.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $0.99 / $2.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.14 / $1.91
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.56 / $3.33 / $5.14
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $5.18 / $9.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.37
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.41 / $2.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.69 / $3.74
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.70 / $17.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $2.11 / $2.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $2.04
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $4.55 / $4.55
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $1.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.93 / $1.03 / $2.29