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Wisconsin rates for HCPCS A4755

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.73 / $5.87 / $7.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.84 / $10.84 / $10.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $8.00 / $11.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $15.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.84 / $15.00 / $15.00