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South Dakota rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.94 / $10.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.51 / $15.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.49 / $15.49 / $19.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $14.79 / $25.12
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $7.76 / $66.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $14.79 / $14.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $23.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $13.49 / $17.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $6.76 / $13.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.02