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Utah rates for HCPCS A4355

Irrigation tubing set for continuous bladder irrigation through a three-way indwelling Foley catheter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $7.08 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $5.89 / $6.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.13 / $5.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $8.71 / $32.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $7.59 / $11.22
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $10.47 / $12.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $10.72 / $12.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $4.79 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $5.25 / $7.59