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South Dakota rates for HCPCS A4380

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.27 / $33.27 / $33.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.27 / $35.65 / $43.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.45 / $34.45 / $57.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.38 / $60.38 / $75.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.65 / $60.27 / $245.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.78 / $31.73 / $59.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.71 / $57.38 / $75.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.91 / $58.17 / $109.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.50 / $50.94 / $60.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $26.02 / $59.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.94 / $46.94 / $46.94