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South Dakota rates for HCPCS A4378

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.40 / $27.40 / $27.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.40 / $29.37 / $35.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.81 / $25.81 / $47.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.88 / $49.88 / $62.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.37 / $49.64 / $201.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.11 / $26.14 / $49.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.29 / $47.26 / $61.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.99 / $47.91 / $90.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.83 / $41.95 / $49.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.18 / $32.35 / $49.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.65 / $38.65 / $38.65