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South Dakota rates for HCPCS A4408

Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 in, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.80 / $8.80 / $8.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.80 / $9.43 / $11.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.28 / $8.28 / $15.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.13 / $16.13 / $20.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.43 / $15.94 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $8.39 / $15.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.62 / $15.17 / $19.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.87 / $15.39 / $29.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.50 / $13.47 / $16.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.58 / $6.88 / $11.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.41 / $12.41 / $12.41