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South Carolina rates for HCPCS A5055

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $1.49 / $1.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.08 / $1.49 / $1.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.97 / $2.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.21 / $1.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $1.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.72 / $2.92
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.26 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.85 / $1.14