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South Dakota rates for HCPCS A4422

Ostomy Absorbent Material (Sheet/Pad/Crystal Packet) For Use In Ostomy Pouch To Thicken Liquid Stomal Output Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.11 / $0.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.38 / $0.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.19 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.10 / $0.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.17 / $0.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.18 / $0.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $0.15
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14