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South Dakota rates for HCPCS A6221

Gauze, nonimpregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $1.69 / $1.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.69 / $1.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $5.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $2.86 / $4.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.74 / $5.74 / $5.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.22 / $5.74 / $6.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00