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South Dakota 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
$16.50 / $16.50 / $16.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.32 / $16.50 / $21.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.54 / $15.54 / $28.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.58 / $30.00 / $37.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.69 / $27.89 / $117.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.93 / $17.85 / $29.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.67 / $28.47 / $37.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.29 / $28.87 / $54.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.69 / $21.89 / $26.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.59 / $14.28 / $18.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.29 / $23.29 / $23.29