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Texas rates for HCPCS A4774

Ammonia test strips, for dialysis, per 50

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $3.20 / $3.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $3.20 / $4.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $6.50 / $6.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $9.00 / $9.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $3.20 / $9.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $3.20 / $9.08
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
$3.00 / $3.00 / $4.20