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Nebraska rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.99 / $1.99 / $1.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $1.99 / $1.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.33 / $2.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $2.65 / $2.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $2.63 / $4.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.79 / $2.64 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.21 / $2.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.64 / $2.65 / $3.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.15 / $3.13 / $5.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.19 / $1.56