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Wisconsin rates for HCPCS A4629

Tracheostomy Care Kit For Established Tracheostomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $3.78 / $3.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.83 / $4.11 / $5.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.50 / $7.15 / $11.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.85 / $6.05 / $7.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.68 / $13.91 / $13.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.90 / $17.12 / $26.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.32 / $9.52 / $12.31
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.77 / $5.41 / $7.48
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.70 / $6.46 / $7.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.15 / $6.80 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $3.30 / $7.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.77 / $5.67 / $7.48
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.70 / $6.46 / $7.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $9.99 / $16.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.90 / $12.70 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.32 / $3.90 / $32.18
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $6.50 / $6.50
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $6.50 / $6.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $3.24 / $6.50