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South Dakota rates for HCPCS A6025

Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.34 / $11.34 / $37.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.34 / $11.34 / $11.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $31.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.21 / $40.13 / $50.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.64 / $19.30 / $31.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.80 / $17.59 / $159.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.36 / $27.87 / $37.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.36 / $26.68 / $34.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.52 / $10.61 / $18.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.80 / $19.80 / $19.80