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South Dakota rates for HCPCS A4433

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.99 / $2.99 / $2.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.99 / $3.21 / $3.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.81 / $2.98 / $5.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $6.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.19 / $5.42 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $2.84 / $5.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.28 / $5.16 / $6.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $5.22 / $9.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.90 / $4.58 / $5.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $2.33 / $3.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.22 / $4.22 / $4.22