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South Dakota rates for HCPCS A4245

Alcohol wipes, per box

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $1.39 / $1.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $6.00 / $7.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.55 / $2.37 / $4.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.08 / $2.15 / $15.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.74 / $3.41 / $4.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $3.27 / $4.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.59 / $2.59 / $2.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.18 / $2.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05