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South Dakota rates for HCPCS A4394

Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fl oz

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $3.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $2.29 / $4.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.17 / $5.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $3.98 / $6.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $2.29 / $18.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $3.98 / $3.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $4.07 / $4.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $3.31 / $6.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.63 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.82 / $3.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $3.24 / $3.24