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South Carolina rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $5.01 / $6.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $7.76 / $9.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.57 / $12.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $3.89 / $8.91
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $4.90 / $5.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $7.08 / $12.59
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.09 / $2.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.57 / $3.02 / $4.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $3.63 / $4.90