go back

South Dakota rates for HCPCS A4383

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $26.92 / $32.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.07 / $26.07 / $43.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.75 / $46.21 / $57.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.91 / $45.49 / $184.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.69 / $23.96 / $45.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.03 / $43.32 / $56.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.90 / $43.93 / $82.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.85 / $38.46 / $45.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.08 / $19.64 / $39.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.44 / $35.44 / $35.44