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South Dakota rates for HCPCS A4364

Adhesive, liquid or equal, any type, per oz

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.62 / $2.62 / $2.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $2.62 / $2.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $7.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.51 / $4.88 / $6.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $3.84 / $4.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.33 / $20.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.50 / $4.68 / $5.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.76 / $4.51 / $6.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.91 / $3.49 / $4.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $2.33 / $5.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.70 / $3.70 / $3.70