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South Dakota rates for HCPCS A4379

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.38 / $13.38 / $13.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.38 / $14.34 / $17.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.91 / $13.91 / $23.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.38 / $24.38 / $30.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.35 / $24.23 / $98.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.36 / $12.77 / $23.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.20 / $23.08 / $30.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.05 / $23.41 / $44.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.50 / $20.49 / $24.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $10.47 / $17.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.88 / $18.88 / $18.88