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North Carolina 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
$2.20 / $2.20 / $2.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.59 / $2.20 / $2.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.44 / $1.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $3.34 / $3.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.75 / $1.88 / $2.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.43 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.51 / $3.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $2.20 / $2.99
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.88 / $2.00 / $2.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $4.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.19 / $1.82
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $80.00 / $80.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.50 / $12.50 / $18.82