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South Dakota rates for HCPCS A4316

Insertion Tray With 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
$25.31 / $25.31 / $25.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.31 / $26.17 / $33.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.37 / $19.37 / $43.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.13 / $46.13 / $57.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.12 / $44.23 / $178.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.25 / $28.04 / $45.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.29 / $43.65 / $57.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.15 / $43.88 / $82.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.92 / $37.38 / $44.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $28.04 / $39.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.71 / $35.71 / $35.71