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Iowa 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
$1.60 / $1.60 / $1.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $1.59 / $2.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $2.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.76 / $3.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $3.13 / $3.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.71 / $2.92 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.27 / $3.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.76 / $2.76 / $3.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $3.23 / $5.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.25 / $3.28
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $2.25 / $2.25