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South Dakota rates for HCPCS A5112

Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $28.84 / $40.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $53.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $69.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $48.98 / $91.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $30.90 / $251.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $48.98 / $53.70
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $87.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $47.86 / $64.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $23.99 / $47.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65