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South Dakota rates for HCPCS A6258

Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.84 / $3.84 / $3.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.84 / $3.84 / $4.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.00 / $9.00 / $11.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.13 / $7.13 / $8.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.64 / $6.54 / $8.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $4.80 / $29.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.60 / $6.87 / $8.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $6.62 / $10.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.03 / $6.02 / $7.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.00 / $5.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $5.42 / $5.42