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South Dakota rates for HCPCS A4680

Activated carbon filter for hemodialysis, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $30.20 / $40.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $51.29 / $72.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $52.48 / $95.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $25.70 / $346.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $72.44 / $102.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $28.84 / $47.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86