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South Dakota rates for HCPCS A4418

Ostomy pouch, closed; without barrier attached, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.61 / $1.61 / $1.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.73 / $2.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $1.69 / $2.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $2.92 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.54 / $2.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.78 / $3.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.83 / $5.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.47 / $2.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.27 / $2.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.27