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South Dakota rates for HCPCS A4392

Ostomy Pouch Urinary With Standard Wear Barrier Attached With Built-In Convexity (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.28 / $7.28 / $7.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $7.81 / $9.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $7.64 / $12.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.13 / $13.13 / $16.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.81 / $13.20 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $6.95 / $13.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.44 / $12.56 / $16.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.84 / $12.74 / $24.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.52 / $11.15 / $13.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.79 / $5.69 / $11.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.28 / $10.28 / $10.28