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South Dakota rates for HCPCS A6404

Gauze Non-Impregnated Sterile Pad Size More Than 48 Sq. In. Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.75 / $0.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $0.39 / $0.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.36 / $5.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.57 / $0.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.57 / $0.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.22 / $0.36
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60