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South Dakota rates for HCPCS A4417

Ostomy Pouch Closed With Barrier Attached With Built-In Convexity With Filter (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.32 / $3.32 / $3.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $3.56 / $4.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.60 / $5.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $7.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.55 / $6.02 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $3.16 / $5.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.76 / $5.73 / $7.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.48 / $5.80 / $10.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $5.09 / $6.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.60 / $4.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.69 / $4.69 / $4.69