go back

South Dakota rates for HCPCS A4423

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $1.65 / $1.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.77 / $2.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $1.66 / $2.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.77 / $2.99 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.58 / $2.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $2.85 / $3.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.90 / $5.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.52 / $3.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.30 / $2.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.33 / $2.33 / $2.33