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South Dakota rates for HCPCS A6257

Transparent film, sterile, 16 sq in or less, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $3.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $2.33 / $4.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.71 / $10.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.45 / $3.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.97 / $2.35 / $3.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $2.27 / $2.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.79 / $2.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $1.93