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South Dakota rates for HCPCS A6454

Self-adherent bandage, elastic, nonknitted/nonwoven, width greater than or equal to 3 in and less than 5 in, per yd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.50 / $1.50 / $1.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.14 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.17 / $1.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.87 / $5.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.26 / $1.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.21 / $1.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.10 / $1.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.55 / $0.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $0.99 / $0.99