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South Dakota rates for HCPCS A6253

Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $6.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.00 / $13.00 / $16.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.13 / $10.13 / $12.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.29 / $9.64 / $12.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.53 / $7.05 / $49.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.69 / $10.09 / $12.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.10 / $9.74 / $14.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.38 / $9.41 / $11.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.94 / $5.64 / $11.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.97 / $7.97 / $7.97