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South Dakota rates for HCPCS A4394

Ostomy Deodorant With Or Without Lubricant For Use In Ostomy Pouch Per Fluid Ounce

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $2.48 / $3.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.18 / $2.29 / $3.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $5.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $4.19 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.29 / $3.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $3.98 / $5.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.11 / $4.03 / $7.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.01 / $3.54 / $4.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $2.41 / $3.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.26 / $3.26 / $3.26