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Oregon rates for HCPCS A5055

Stoma Cap (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $1.47 / $5.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $1.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $3.54 / $4.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.44 / $1.76 / $2.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.81 / $2.11
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.81 / $1.95 / $2.21
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $2.00 / $2.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.72 / $2.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.76 / $2.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.21 / $2.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $0.85 / $1.62