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South Dakota rates for HCPCS A6219

Gauze, nonimpregnated, sterile, pad size 16 sq in or less, with any size adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.85 / $0.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.85 / $0.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.50 / $1.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.44 / $2.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $1.07 / $7.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $1.53 / $1.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.47 / $2.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.41 / $1.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $1.07 / $1.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20