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Maine 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
$0.68 / $1.44 / $1.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $1.51 / $1.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.44 / $1.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.25 / $2.89