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South Dakota rates for HCPCS A5056

Ostomy pouch, drainable, with extended wear barrier attached, with filter, (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.47 / $5.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.93 / $4.16 / $7.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $7.50 / $9.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.26 / $7.25 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $4.16 / $7.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.97 / $7.18 / $9.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.61 / $7.28 / $13.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.44 / $6.38 / $7.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $3.26 / $5.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.88 / $5.88 / $5.88