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South Dakota rates for HCPCS A6403

Gauze Non-Impregnated Sterile Pad Size More Than 16 Sq. In. Less Than Or Equal To 48 Sq. In. Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.64 / $0.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.47 / $3.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $0.66 / $0.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.64 / $0.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.64 / $0.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.28 / $0.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.51 / $0.51