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Wisconsin rates for HCPCS A4708

Acetate Conc Sol Per Gallon

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
$15.01 / $22.55 / $30.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $11.70 / $11.70
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
$16.20 / $16.20 / $16.20
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
$11.70 / $16.20 / $16.20