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Washington rates for HCPCS A4929

Tourniquet for dialysis, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.27 / $0.35
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $90.00 / $90.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $2.16 / $2.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.27
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.56 / $0.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.55 / $0.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.66 / $0.67
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.71 / $0.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.70 / $1.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.22 / $0.36
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33