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South Dakota rates for HCPCS A4387

Ostomy Pouch Closed With Barrier Attached With Built-In Convexity (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.15 / $2.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $3.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.75 / $3.75 / $4.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.93 / $3.63 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $2.09 / $3.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.87 / $3.45 / $4.51
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $3.58 / $6.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $3.07 / $3.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.57 / $2.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.83 / $2.83 / $2.83