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South Dakota rates for HCPCS A4425

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.19 / $3.19 / $3.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $3.42 / $4.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.19 / $5.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.63 / $5.68 / $7.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.42 / $5.78 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.33 / $5.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.58 / $5.50 / $7.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.30 / $5.59 / $10.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.18 / $4.88 / $5.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $2.50 / $4.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.50 / $4.50