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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
$36.31 / $36.31 / $36.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $36.31 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $36.31 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $81.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $61.66 / $107.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $32.36 / $281.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $61.66 / $61.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $102.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $56.23 / $74.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $28.18 / $57.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29