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South Dakota rates for HCPCS A5057

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.56 / $8.56 / $8.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.56 / $9.17 / $11.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.53 / $14.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.38 / $15.38 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.52 / $14.89 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.35 / $8.55 / $15.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.28 / $14.75 / $19.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $14.97 / $28.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.19 / $13.10 / $15.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.70 / $13.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.07 / $12.07 / $12.07