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Wisconsin rates for HCPCS A4911

Drain bag/bottle, for dialysis, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.00 / $8.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.03 / $21.03 / $21.03
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $14.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.12 / $29.12 / $29.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $11.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.03 / $29.12 / $29.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.64 / $9.64 / $11.34