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South Dakota rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $6.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $8.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $6.61 / $11.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $3.47 / $29.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $6.61 / $6.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.50 / $10.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $6.03 / $7.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $3.02 / $6.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $5.37 / $5.37