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Wisconsin rates for HCPCS A4766

Dialysate conc sol add 10 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.01 / $22.51 / $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
$2.70 / $2.70 / $2.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.80 / $5.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.80 / $7.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.74 / $3.74 / $3.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.80 / $5.32
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $3.74 / $3.74