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South Dakota rates for HCPCS A4416

Ostomy pouch, closed, with barrier attached, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.63 / $3.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.45 / $4.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.50 / $5.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.63 / $4.44 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $2.34 / $4.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.52 / $4.24 / $5.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $4.30 / $8.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.21 / $3.76 / $4.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $2.20 / $3.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $3.47 / $3.47