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South Dakota rates for HCPCS A4399

Ostomy irrigation supply; cone/catheter, with or without brush

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.93 / $10.93 / $10.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.93 / $11.72 / $12.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.29 / $12.72 / $16.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.88 / $19.88 / $24.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.72 / $19.80 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.71 / $10.42 / $17.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.32 / $16.03 / $24.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.50 / $16.23 / $30.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.29 / $16.73 / $19.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.69 / $8.55 / $17.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.11 / $13.11 / $13.11