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Virginia rates for HCPCS A5055

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.25 / $1.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $0.99 / $1.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.36 / $1.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $1.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.00 / $2.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $1.33 / $2.31
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.64 / $3.34
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.59 / $2.74
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.59 / $2.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.00 / $1.44