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South Dakota rates for HCPCS A4315

Insertion tray with drainage bag with indwelling catheter, Foley type, two-way, all silicone

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.50 / $23.50 / $23.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.50 / $25.19 / $30.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.29 / $22.13 / $40.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.54 / $42.75 / $53.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.19 / $42.57 / $165.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.69 / $26.04 / $42.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.70 / $40.54 / $53.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.74 / $41.12 / $77.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.75 / $35.99 / $42.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.24 / $26.04 / $37.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.17 / $33.17 / $33.17