go back

South Dakota rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Facilitymedian $17 · 10th–90th $15–$300%20%10th90th$17Professionalmedian $19 · 10th–90th $13–$320%10%20%10th90th$19$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.14 / $26.92
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $15.85 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $27.54 / $34.67
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $26.30 / $44.67
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.55 / $15.14 / $120.23
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $26.30 / $26.30
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $26.92
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $21.88 / $42.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $23.99 / $31.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $15.85 / $28.18
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.38 / $21.38 / $21.38