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South Dakota rates for HCPCS A4355

Irrigation Tubing Set For Continuous Bladder Irrigation Through A Three-Way Indwelling Foley Catheter Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.95 / $7.95 / $7.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $7.95 / $10.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.85 / $5.85 / $13.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $14.63 / $18.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.43 / $12.24 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.22 / $8.44 / $14.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.28 / $13.55 / $17.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $13.75 / $25.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.84 / $10.34 / $12.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $6.15 / $12.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.09 / $11.09 / $11.09