go back

South Dakota rates for HCPCS A5071

Ostomy Pouch Urinary; With Barrier Attached (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.35 / $5.35 / $5.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.35 / $5.74 / $7.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.04 / $5.34 / $9.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.75 / $9.75 / $12.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.74 / $9.69 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.35 / $5.11 / $9.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.68 / $9.24 / $12.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.22 / $9.36 / $17.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $8.19 / $9.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $4.19 / $11.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.56 / $7.56 / $7.56