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South Carolina rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.94 / $10.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $13.80 / $16.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.24 / $8.13 / $21.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $15.49
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $8.71 / $9.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $12.02 / $21.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $3.72 / $4.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $9.12 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $5.25 / $8.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $6.46 / $8.71