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South Dakota rates for HCPCS A4680

Activated carbon filter, ea

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.54 / $30.54 / $41.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.29 / $50.75 / $70.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.57 / $51.98 / $84.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.69 / $28.58 / $344.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.50 / $71.84 / $101.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.21 / $71.84 / $92.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.57 / $25.98 / $47.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $75.00