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South Dakota rates for HCPCS A5126

Adhesive or nonadhesive; disk or foam pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.99 / $0.99 / $0.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $1.25 / $1.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.10 / $1.10 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.88 / $1.89 / $2.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.27 / $2.11 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $1.12 / $2.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $2.00 / $2.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.59 / $2.04 / $3.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.79 / $2.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $1.22 / $1.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.65 / $1.65