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Pennsylvania 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
$1.23 / $1.23 / $1.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.54 / $2.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $2.50 / $2.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $2.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.78
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $2.31 / $3.40
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.60 / $1.88
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.54 / $2.20
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $3.40 / $5.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $2.94
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $3.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.79 / $2.39 / $2.39
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $2.39 / $2.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.25 / $2.25