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Wisconsin rates for HCPCS A4707

Bicarbonate conc pow per pac

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.14 / $5.14 / $5.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.40 / $5.14 / $5.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $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
$4.18 / $4.18 / $4.18
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.40 / $5.14 / $5.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.40 / $5.14 / $5.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.79 / $5.79 / $5.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.14 / $5.14 / $5.64
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.18 / $5.79 / $5.79