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Utah 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
$10.86 / $10.86 / $10.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.86 / $21.15 / $114.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.37 / $19.37 / $19.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.19 / $16.46 / $28.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.75 / $29.07 / $39.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.06 / $27.78 / $41.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $16.82 / $29.76