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South Dakota rates for HCPCS A4430

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $8.13 / $9.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.15 / $7.57 / $13.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.88 / $13.88 / $17.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.14 / $13.74 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.74 / $7.24 / $13.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.88 / $13.09 / $17.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.24 / $13.27 / $25.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.92 / $11.62 / $13.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.95 / $5.93 / $15.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.71 / $10.71 / $10.71