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Tennessee rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $1.06 / $1.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.30 / $1.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.85 / $1.85
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.16 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.70 / $17.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.96 / $1.48