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South Dakota rates for HCPCS A6216

Gauze, nonimpregnated, nonsterile, pad size 16 sq in or less, without adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.38 / $0.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.07 / $0.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.05 / $3.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.07 / $0.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.05 / $0.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05