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Wisconsin rates for HCPCS A4720

Dialysat sol fld vol > 249cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.67 / $19.67 / $19.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.67 / $19.67 / $19.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.75 / $15.00 / $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
$14.11 / $14.11 / $14.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.67 / $19.67 / $21.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.67 / $19.67 / $26.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.53 / $19.53 / $19.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.67 / $19.67 / $21.64
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.11 / $19.53 / $19.53