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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

Facilitymedian $9 · 10th–90th $8$170%20%40%10th90th$9Professionalmedian $11 · 10th–90th $7$190%10%20%10th90th$11$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
Setting
Facility
Modifier
Global
Typical Low
$7.94
Median
$7.94
Typical High
$7.94
Aetna
Setting
Professional
Modifier
Global
Typical Low
$7.08
Median
$7.94
Typical High
$18.20
Avera
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$14.79
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$15.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$15.49
Typical High
$19.05
Medica
Setting
Facility
Modifier
Global
Typical Low
$9.12
Median
$14.45
Typical High
$25.12
Medica
Setting
Professional
Modifier
Global
Typical Low
$5.37
Median
$8.51
Typical High
$66.07
Midlands
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$14.79
Typical High
$14.79
Midlands
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$15.14
Typical High
$15.14
Midlands
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$23.99
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$13.49
Typical High
$17.78
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$8.91
Typical High
$15.85
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$12.02