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South Dakota rates for HCPCS A4398

Ostomy Irrigation Supply; Bag Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.31 / $12.31 / $12.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.10 / $12.31 / $16.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.60 / $14.33 / $21.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.50 / $22.50 / $28.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.58 / $20.45 / $89.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.05 / $11.28 / $22.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.67 / $21.24 / $27.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.62 / $21.55 / $40.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.76 / $17.29 / $20.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.41 / $9.64 / $19.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $17.38