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Wisconsin rates for HCPCS A4690

Dialyzer (Artificial Kidneys) All Types All Sizes For Hemodialysis Each (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.86 / $256.86 / $256.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.59 / $332.60 / $426.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.91 / $522.14 / $1,530.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,193.08 / $1,394.21 / $2,138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.63 / $620.63 / $903.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.51 / $348.59 / $615.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.18 / $359.60 / $840.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.44 / $283.23 / $3,418.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $60.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.86 / $354.95 / $718.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.28 / $998.40 / $1,414.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.65 / $833.36 / $2,315.16
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.63 / $2,239.90 / $3,418.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.19 / $269.26 / $508.98