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South Dakota rates for HCPCS A4367

Ostomy Belt Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.56 / $6.56 / $6.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $7.03 / $7.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.18 / $6.54 / $10.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $15.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.03 / $11.88 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $6.25 / $11.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.61 / $11.29 / $14.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.76 / $11.47 / $21.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.57 / $10.03 / $11.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.64 / $6.84 / $10.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.49 / $8.49 / $8.49