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South Dakota rates for HCPCS A4419

Ostomy pouch, closed; for use on barrier with nonlocking flange, with filter (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $1.53 / $1.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.65 / $2.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.54 / $2.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.65 / $3.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $2.79 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.48 / $2.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.65 / $3.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.70 / $5.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.35 / $2.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.21 / $2.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.17 / $2.17