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South Dakota rates for HCPCS A4389

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

Facilitymedian $6 · 10th–90th $5–$110%20%40%10th90th$6Professionalmedian $6 · 10th–90th $4–$110%20%10th90th$6$5.0$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $5.01 / $10.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.25 / $5.25 / $9.77
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.23 / $10.23 / $12.59
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $9.33 / $16.22
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.47 / $5.50 / $43.65
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $9.55 / $9.55
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.77 / $9.77 / $9.77
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $7.94 / $15.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.24 / $8.71 / $11.48
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.88 / $5.75 / $10.23
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.76 / $7.76 / $7.76