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South Dakota rates for HCPCS A4626

Tracheostomy cleaning brush, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.77 / $2.77 / $2.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.59 / $2.77 / $3.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.68 / $3.31 / $4.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.82 / $4.88 / $6.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.05 / $4.38 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.42 / $5.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $4.23 / $6.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.42 / $4.23 / $7.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $3.70 / $4.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.21 / $4.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.23 / $4.23 / $4.23