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South Dakota rates for HCPCS A4426

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.43 / $2.43 / $2.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.43 / $2.60 / $3.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.42 / $4.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.50 / $5.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $4.38 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $2.31 / $4.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.49 / $4.19 / $5.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.29 / $4.26 / $8.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.18 / $3.72 / $4.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.90 / $3.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $3.43 / $3.43