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Ohio 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
$1.59 / $1.59 / $4.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.59 / $2.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $3.26
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.88 / $2.50 / $3.39
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.63 / $2.50 / $5.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $1.51 / $3.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.78
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $3.15
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.51 / $1.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $1.79 / $2.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $1.18 / $1.61