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Virginia 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
$1.27 / $1.27 / $1.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.27 / $1.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.14 / $1.52
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.65 / $1.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $2.04 / $2.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $1.44 / $2.46
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.69 / $3.41
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.63 / $3.03
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.63 / $3.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $1.03 / $1.74