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South Carolina rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.17 / $7.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $3.63 / $9.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $7.08
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.89 / $4.27
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.55 / $5.50 / $9.77
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.62 / $2.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $4.07 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.34 / $3.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.88 / $3.89