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South Dakota rates for HCPCS A5121

Skin barrier; solid, 6 x 6 or equivalent, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.24 / $6.24 / $6.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.24 / $7.12 / $8.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.26 / $6.89 / $11.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.25 / $11.36 / $14.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $12.03 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $6.34 / $11.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.52 / $11.45 / $14.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.97 / $11.62 / $21.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.68 / $10.17 / $12.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.46 / $5.20 / $10.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.36 / $9.36 / $9.36