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Texas rates for HCPCS A4623

Tracheostomy Inner Cannula. (Rvsd 1/1/04) Ecial Coverage Instructions Apply. See Cim: 65-16)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $5.12 / $6.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $5.12 / $7.37
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.82 / $5.45 / $6.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.70 / $8.63 / $21.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.71 / $3.75 / $4.17
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.82 / $6.23 / $9.65
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.79 / $95.62 / $95.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.67 / $5.50 / $6.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $4.68 / $6.62
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.62 / $45.62 / $68.70
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $5.86 / $7.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.76 / $7.01 / $7.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $5.59 / $7.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $4.68 / $6.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $4.22 / $5.57
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.90 / $3.90 / $7.79