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South Dakota rates for HCPCS A4411

Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.98 / $6.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $4.57 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $8.32 / $10.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $7.76 / $13.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $4.07 / $35.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $7.76 / $7.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $6.46 / $12.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $7.08 / $9.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $3.55 / $7.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $6.46 / $6.46