go back

Wisconsin rates for HCPCS A4706

Bicarbonate Concentrate Solution For Hemodialysis Per Gallon (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $15.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.24 / $15.24 / $15.24
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $8.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.11 / $21.11 / $21.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.60
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.24 / $21.11 / $21.11