go back

California rates for HCPCS A5054

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $10.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.93 / $1.20 / $2.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.32 / $2.75
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.63 / $3.63 / $5.37
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $4.68 / $9.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.29 / $1.58
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.63 / $3.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $2.29 / $4.47
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $85.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $18.62 / $18.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $2.40 / $3.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.29 / $2.45
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $3.24 / $5.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.18 / $0.95 / $1.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $1.12 / $2.51