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Virginia 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
$1.55 / $1.55 / $1.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.55 / $1.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.66
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.69 / $1.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.88 / $2.50 / $3.01
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $1.66 / $2.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.30 / $4.18
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.98 / $3.43
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.98 / $3.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.25 / $1.79