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South Dakota rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.05 / $8.05 / $8.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.05 / $8.63 / $10.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $8.03 / $13.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.63 / $14.63 / $18.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.63 / $14.58 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $7.68 / $14.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.55 / $13.89 / $18.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.88 / $14.10 / $26.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.54 / $12.33 / $14.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.19 / $6.30 / $10.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.37 / $11.37 / $11.37