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South Dakota rates for HCPCS A6231

Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq in or less, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.18 / $4.18 / $4.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.18 / $4.18 / $4.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $12.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $7.50 / $9.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.13 / $7.11 / $8.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $5.22 / $32.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.19 / $7.47 / $9.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $7.21 / $11.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $6.55 / $8.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $3.27 / $6.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.90 / $5.90 / $5.90