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South Carolina rates for HCPCS A5053

Ostomy Pouch Closed; For Use On Faceplate Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.64 / $1.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $2.04 / $2.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.14 / $1.37 / $1.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.66
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $1.89 / $3.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.98 / $1.31