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South Dakota rates for HCPCS A4455

Adhesive remover or solvent (for tape, cement or other adhesive), per oz

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $3.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.88 / $1.89 / $2.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $2.17 / $2.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.59 / $9.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.18 / $2.25 / $2.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $2.19 / $3.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.67 / $1.99 / $2.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.58 / $1.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $1.79 / $1.79