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South Carolina rates for HCPCS A5054

Ostomy Pouch Closed; For Use On Barrier With Flange (2 Piece) Each (Updated 01-01-2003) M: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.00 / $2.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $2.46 / $3.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.51 / $1.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.51 / $1.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $2.12 / $3.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.69 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.12 / $1.50