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Alaska rates for HCPCS A5054

Ostomy pouch, closed; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $2.39 / $2.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.51 / $1.56
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.68
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $2.38 / $3.77
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.20 / $2.20 / $2.45
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.45 / $5.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.68 / $2.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.02 / $3.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $2.40