go back

South Dakota rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $5.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $6.23 / $7.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.79 / $10.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.50 / $10.50 / $13.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.22 / $10.53 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $5.53 / $10.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.33 / $10.02 / $13.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.83 / $10.15 / $19.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $8.90 / $10.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $4.54 / $7.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.19 / $8.19 / $8.19