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Wisconsin rates for HCPCS A4890

Contracts, Repair and Maintenance, for Home Dialysis Equipment (Non-Co

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.94 / $254.94 / $254.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.60 / $254.94 / $254.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $27.50 / $31.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.30 / $11.30 / $11.30
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.05 / $254.94 / $356.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.05 / $254.94 / $530.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.64 / $15.64 / $15.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.05 / $254.94 / $356.92
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.30 / $15.64 / $15.64