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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
$3.82 / $3.82 / $3.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.82 / $4.09 / $5.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $6.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.13 / $7.13 / $8.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $6.93 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $3.65 / $6.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.48 / $6.59 / $8.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.17 / $6.69 / $12.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.85 / $6.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.99 / $4.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.39 / $5.39 / $5.39