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South Dakota rates for HCPCS A4382

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $20.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $20.89 / $28.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $20.89 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $50.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.44 / $38.02 / $64.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $19.50 / $169.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $38.02 / $38.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $61.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $34.67 / $45.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $16.98 / $34.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90