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Tennessee 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
$1.30 / $1.30 / $1.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.09 / $1.59 / $2.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $2.25 / $2.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.09 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.50 / $12.50 / $18.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.17 / $1.52