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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $15.85 / $21.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $15.49 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $37.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $26.30 / $43.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $14.79 / $162.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $28.18 / $28.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $39.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $22.39 / $29.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $12.30 / $26.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $23.44