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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
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $3.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $3.31 / $4.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $6.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $4.90 / $8.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.51 / $21.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $4.90 / $4.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.76 / $7.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $4.37 / $5.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.19 / $4.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98