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Wisconsin rates for HCPCS A4774

Ammonia Test Strips

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
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $405.00
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
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $3.20 / $6.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $3.20 / $6.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $9.00 / $9.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $3.20 / $5.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.50 / $9.00 / $9.00