go back

Wisconsin 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
$5.32 / $5.32 / $5.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $5.53 / $7.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.16 / $10.08 / $16.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.24 / $8.52 / $11.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.58 / $19.60 / $19.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $24.33 / $37.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $13.34 / $17.35
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $7.45 / $10.53
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $7.79 / $10.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.46 / $9.16 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.69 / $4.68 / $10.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $7.98 / $10.53
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $7.79 / $10.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.16 / $14.08 / $23.09
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.62 / $17.89 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $5.67 / $45.62
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.16 / $9.16 / $9.16
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.16 / $9.16 / $9.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $4.57 / $9.16