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Wisconsin rates for HCPCS A4750

Blood Tubing Arterial Or Venous For Hemodialysis Each (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.91 / $4.91 / $4.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.99 / $6.36 / $8.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.32 / $9.98 / $29.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.53 / $26.33 / $40.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.87 / $11.72 / $17.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.73 / $6.66 / $11.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.82 / $6.86 / $16.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.76 / $5.41 / $67.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.91 / $6.78 / $13.73
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.58 / $19.07 / $27.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.59 / $15.92 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.87 / $42.80 / $67.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.42 / $5.14 / $9.24