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Oregon rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.37 / $1.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $4.25 / $5.21
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $2.12 / $2.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $2.29 / $2.52
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $2.35 / $2.77
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.41 / $2.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $2.06 / $2.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $2.11 / $2.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $2.65 / $2.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.03 / $2.00