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Wisconsin rates for HCPCS A4737

Injectable anesthetic, for dialysis, per 10 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $202.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.93 / $4.93 / $4.93
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.00 / $5.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.83 / $6.83 / $6.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.93 / $6.83 / $6.83