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South Dakota rates for HCPCS A5062

Ostomy pouch, drainable; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.99 / $1.99 / $1.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.98 / $1.99 / $2.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.87 / $2.08 / $3.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.70 / $3.75 / $4.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $3.35 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.86 / $3.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.66 / $3.19 / $4.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $3.25 / $6.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.43 / $2.83 / $3.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.94 / $3.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61