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South Dakota rates for HCPCS A4391

Ostomy Pouch Urinary With Extended Wear Barrier Attached (1 Piece) Each (Updated 01-01-2003) Ch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.30 / $6.30 / $6.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.30 / $6.75 / $8.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $6.28 / $10.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.63 / $11.63 / $14.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.75 / $11.41 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.94 / $6.01 / $11.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.02 / $10.86 / $14.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.50 / $11.02 / $20.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.24 / $9.64 / $11.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $4.93 / $8.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.88 / $8.88 / $8.88