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South Dakota rates for HCPCS A5131

Appliance Cleaner Incontinence And Ostomy Appliances Per 16 Oz. (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.01 / $12.01 / $12.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.01 / $15.14 / $15.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.92 / $13.30 / $20.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.75 / $21.75 / $27.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $24.57 / $102.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.61 / $13.48 / $22.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.22 / $20.71 / $31.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.75 / $21.00 / $39.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.48 / $21.63 / $25.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.36 / $10.43 / $18.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.95 / $16.95 / $16.95