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Wisconsin rates for HCPCS A4765

Dialysate concentrate, powder, additive for peritoneal dialysis, per packet

Facilitymedian $5 · 10th–90th $5–$650%50%90th$5Professionalmedian $5 · 10th–90th $5–$50%50%90th$5$1.0$5.0$20.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $5.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.68 / $2.00 / $2.19
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.50 / $5.50 / $7.59
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.14 / $2.34 / $3.16
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.50 / $5.50 / $8.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $6.03 / $6.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $54.95 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $6.03 / $6.03