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South Dakota rates for HCPCS A5073

Ostomy pouch, urinary; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.83 / $2.83 / $2.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.83 / $3.00 / $3.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.67 / $3.30 / $4.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $6.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $5.07 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.75 / $2.70 / $5.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.87 / $6.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.84 / $4.96 / $9.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.65 / $4.28 / $5.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.21 / $4.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.94 / $3.94 / $3.94