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Wisconsin rates for HCPCS A4719

"Y set" tubing for peritoneal dialysis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $9.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $3.31 / $457.09
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $4.27
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $87.10 / $117.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $5.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $75.86 / $457.09
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $28.18