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South Dakota rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Facilitymedian $7 · 10th–90th $6–$120%20%40%10th90th$7Professionalmedian $8 · 10th–90th $5–$140%20%10th90th$8$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
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $6.03 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $10.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $14.45
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.76 / $10.72 / $18.62
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $6.31 / $48.98
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $10.72 / $10.96
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $10.96
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $9.12 / $17.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.32 / $9.77 / $13.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.31 / $6.61 / $11.48
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.91 / $8.91 / $8.91