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Maine rates for HCPCS A5055

Stoma Cap (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.14 / $1.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $0.99 / $0.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.21 / $1.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $1.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.14 / $1.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $1.00 / $2.31