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South Carolina rates for HCPCS A4391

Ostomy Pouch Urinary With Extended Wear Barrier Attached (1 Piece) Each (Updated 01-01-2003) Ch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.90 / $7.90 / $7.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $7.90 / $8.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $8.83 / $11.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.52 / $5.93 / $5.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.93 / $6.98
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.30 / $8.48 / $15.51
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.67 / $6.67 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $4.45 / $5.66