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South Carolina 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
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $2.57 / $3.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.51 / $4.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.29 / $3.02
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.62 / $1.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $2.19 / $4.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.70 / $1.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.98 / $1.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.20 / $1.62