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South Dakota rates for HCPCS A5054

Ostomy Pouch Closed; For Use On Barrier With Flange (2 Piece) Each (Updated 01-01-2003) M: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.72 / $2.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.60 / $2.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.68 / $2.91 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.52 / $2.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.76 / $3.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.80 / $5.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.10 / $2.45 / $2.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.25 / $2.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25