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South Dakota rates for HCPCS A5055

Stoma cap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.35 / $1.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.28 / $2.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.27 / $2.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $2.27 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.22 / $2.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.84 / $2.21 / $2.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.21 / $4.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.93 / $2.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.99 / $2.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $1.81 / $1.81