go back

South Dakota rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $1.53 / $1.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $1.53 / $2.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $2.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $2.63 / $3.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $2.54 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $1.31 / $2.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.65 / $3.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.70 / $5.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.72 / $2.00 / $2.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.13 / $2.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.17 / $2.17