go back

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
$15.14 / $15.14 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $15.14 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $34.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $26.30 / $44.67
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $13.80 / $120.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $26.30 / $26.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $26.92 / $26.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $42.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $23.99 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $12.02 / $23.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $21.38 / $21.38