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South Dakota rates for HCPCS A5072

Ostomy Pouch Urinary; Without Barrier Attached (1piece) Each (Updated 01-01-2003) 30)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.15 / $3.15 / $3.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.15 / $3.29 / $4.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $2.86 / $5.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.63 / $5.63 / $7.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.37 / $5.56 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.92 / $2.99 / $5.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $5.39 / $7.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $5.39 / $10.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.70 / $5.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.75 / $3.20 / $4.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.45 / $4.45 / $4.45