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South Dakota rates for HCPCS A4396

Ostomy Belt With Peristomal Hernia Support

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.07 / $36.07 / $36.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.07 / $38.65 / $47.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.97 / $35.97 / $62.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.63 / $65.63 / $82.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.05 / $65.34 / $265.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.53 / $34.40 / $64.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.73 / $62.22 / $81.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.70 / $63.08 / $118.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.18 / $55.23 / $65.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.78 / $28.22 / $48.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $50.90 / $50.90