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Virginia rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.15 / $2.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.66 / $1.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $2.29 / $3.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.74 / $2.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.70 / $3.02
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.38 / $1.51
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.86 / $7.08
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.86 / $7.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.93 / $1.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.93 / $1.20 / $1.82