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South Carolina rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $19.05 / $19.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $15.14 / $20.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $24.55 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $15.85 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $15.85
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $15.49 / $17.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $21.88 / $38.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $6.61 / $8.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $9.33 / $15.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $11.48 / $15.49