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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
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $3.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.29 / $3.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.07 / $10.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.34 / $2.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $3.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.29 / $2.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.91 / $2.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $1.95