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Texas rates for HCPCS A4719

Y Set Tubing For Peritoneal Dialysis (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.00 / $11.00 / $11.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.44 / $16.44 / $16.44
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $75.34
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.00 / $8.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.00 / $8.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $7.00 / $9.80