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South Carolina rates for HCPCS A4389

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.94 / $6.94 / $6.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.73 / $6.94 / $7.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $7.56 / $10.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.69 / $5.22 / $5.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.22 / $6.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.86 / $7.46 / $13.63
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.87 / $5.87 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $3.91 / $5.22