go back

Wisconsin rates for HCPCS A4724

Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc, but less than or equal to 4999 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.41 / $18.41 / $18.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $18.41 / $18.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $17.25 / $30.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.41 / $18.41 / $25.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.41 / $18.41 / $38.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.41 / $18.41 / $25.77
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $72.00 / $90.00