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South Dakota rates for HCPCS A5105

Urinary suspensory with leg bag, with or without tube, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $36.31 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $83.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $60.26 / $102.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $34.67 / $363.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $53.70 / $63.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $97.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $53.70 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $28.18 / $57.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29