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South Dakota rates for HCPCS A5063

Ostomy Pouch Drainable; For Use On Barrier With Flange (2 Piece System) Each Ly. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.41 / $2.41 / $2.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $2.58 / $3.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.40 / $4.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.50 / $5.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.58 / $4.36 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.29 / $4.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.45 / $4.16 / $5.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.26 / $4.21 / $7.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.15 / $3.69 / $4.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.88 / $3.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.40 / $3.40 / $3.40