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Wisconsin rates for HCPCS A4315

Insertion Tray With Drainage Bag With Indwelling Catheter Foley Type Two-Way All Silicone (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.40 / $21.40 / $21.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $21.40 / $28.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.85 / $40.54 / $67.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.15 / $34.27 / $45.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.51 / $78.86 / $78.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.13 / $99.12 / $153.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.80 / $53.44 / $69.75
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.09 / $30.87 / $42.38
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.11 / $36.85 / $44.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.94 / $38.52 / $165.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.62 / $18.84 / $42.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.92 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.09 / $32.10 / $42.38
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.11 / $36.85 / $44.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.85 / $56.72 / $93.34
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.13 / $71.98 / $165.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.80 / $22.13 / $194.85
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.85 / $36.85 / $36.85
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.85 / $36.85 / $36.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.02 / $18.38 / $36.85