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South Dakota rates for HCPCS A7504

Filter for use in a tracheostoma heat and moisture exchange system, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.61 / $0.61 / $0.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.65 / $0.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.57 / $0.71 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.64 / $1.10 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.56 / $1.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.88 / $1.05 / $1.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.06 / $2.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.93 / $1.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.48 / $0.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90