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South Carolina rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.10 / $10.10 / $10.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.52 / $10.10 / $11.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $11.35 / $15.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.95 / $7.59 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $7.59 / $8.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.07 / $10.85 / $19.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.53 / $8.53 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $5.69 / $7.59