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South Dakota rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.42 / $1.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.25 / $2.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.29 / $2.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.40 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.27 / $2.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.90 / $2.29 / $2.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $2.31 / $4.36
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.02 / $2.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.04 / $1.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $1.87 / $1.87