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Nebraska 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
$2.08 / $2.08 / $2.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $2.08 / $2.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.43 / $2.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $2.76 / $2.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.76 / $4.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $2.50 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.25 / $2.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.76 / $2.76 / $3.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $3.26 / $5.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.25 / $1.60