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Wisconsin 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
$22.91 / $22.91 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $22.91 / $33.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $40.74 / $66.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $38.02 / $44.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $123.03 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $53.70 / $75.86
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $33.11 / $57.54
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $60.26 / $74.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $39.81 / $177.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $20.42 / $45.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $60.26 / $107.15
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $81.28 / $190.55
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $19.50 / $199.53
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $18.20 / $25.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.95 / $33.88