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Wisconsin rates for HCPCS A4765

Dialysate Conc Pow Per Pack

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.45 / $5.45 / $5.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $5.45 / $5.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.34 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.37
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.45 / $5.45 / $7.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.45 / $5.45 / $11.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.06 / $6.06 / $6.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.45 / $5.45 / $7.63
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $6.06 / $6.06