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Michigan rates for HCPCS A4313

Insertion Tray Without Drainage Bag With Indwelling Catheter Foley Type Three-Way For Continuous Irrigation (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.75 / $16.75 / $16.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.28 / $16.75 / $16.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.29 / $66.93 / $120.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.90 / $22.00 / $29.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.82 / $16.82 / $16.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.70 / $20.70 / $20.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.54 / $15.54 / $16.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.21 / $15.54 / $19.20
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.90 / $15.90 / $16.75
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $16.75 / $24.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.12 / $13.91 / $18.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $10.06 / $13.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.59 / $10.52 / $15.74