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South Dakota rates for HCPCS A4435

Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $5.13 / $5.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.50 / $6.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.84 / $4.84 / $8.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.38 / $9.38 / $11.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.63 / $9.30 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.21 / $5.14 / $9.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.37 / $8.86 / $11.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.95 / $8.99 / $16.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $7.86 / $9.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $4.01 / $6.70
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.25 / $7.25 / $7.25