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Iowa rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.50 / $1.53 / $1.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.49 / $1.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $2.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $2.15 / $3.28
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $3.96 / $4.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $2.79 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $1.22 / $3.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.64 / $2.65 / $3.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $3.09 / $5.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $1.21 / $2.82
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $2.17 / $2.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.71 / $2.17 / $2.17