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South Dakota rates for HCPCS A4381

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.12 / $4.12 / $4.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.12 / $4.42 / $5.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.88 / $3.88 / $7.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $7.50 / $9.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.40 / $7.47 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.58 / $3.92 / $7.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.92 / $7.11 / $9.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.56 / $7.21 / $13.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.39 / $6.31 / $7.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $3.23 / $8.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $5.81