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Wisconsin rates for HCPCS A4223

Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $32.36 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $190.55 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $75.86 / $87.10
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $30.90
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $275.42 / $371.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $36.31 / $147.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $70.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $5,888.44
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $169.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $18.62 / $37.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88