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South Dakota rates for HCPCS A6154

Wound pouch, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.81 / $12.81 / $12.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.81 / $12.81 / $13.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $37.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.25 / $23.25 / $29.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.71 / $21.83 / $27.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $15.99 / $99.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.01 / $22.89 / $28.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.36 / $22.08 / $33.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.73 / $20.07 / $26.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.67 / $15.99 / $23.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.05 / $18.05 / $18.05