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South Dakota rates for HCPCS A4314

Insertion tray with drainage bag with indwelling catheter, Foley type, two-way latex with coating (Teflon, silicone, silicone elastomer or hydrophilic, etc.)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.53 / $22.53 / $22.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.53 / $24.14 / $29.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.60 / $21.22 / $38.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.88 / $40.88 / $51.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.14 / $40.79 / $157.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.08 / $24.96 / $40.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.31 / $38.85 / $50.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.42 / $39.40 / $74.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.46 / $34.49 / $41.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.73 / $17.62 / $29.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.79 / $31.79 / $31.79