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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
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.26 / $2.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.29 / $4.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.20 / $14.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $2.29 / $2.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.34 / $2.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $3.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.09 / $2.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.05 / $2.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $1.86