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South Dakota rates for HCPCS A4375

Ostomy Pouch Drainable With Faceplate Attached Plastic Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.30 / $15.30 / $15.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $16.39 / $20.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $26.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.75 / $28.03 / $34.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.39 / $27.72 / $112.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.56 / $14.60 / $27.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.95 / $26.39 / $34.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.66 / $26.77 / $50.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.02 / $23.43 / $27.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.97 / $11.97 / $23.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.59 / $21.59 / $21.59