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Utah rates for HCPCS A4316

Insertion tray with drainage bag with indwelling catheter, Foley type, three-way, for continuous irrigation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $25.12 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $19.50 / $19.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.60 / $19.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $30.20 / $38.90
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $28.18 / $38.02
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $39.81 / $40.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $40.74 / $41.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $15.14 / $15.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $16.98 / $23.99