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Wisconsin rates for HCPCS A4721

Dialysat sol fld vol > 999cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.38 / $14.25 / $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
$28.33 / $28.33 / $28.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $28.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.22 / $39.22 / $39.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $60.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $22.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.33 / $39.22 / $39.22