Dialysis filter, single unit

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Dialyzer F160 Fresenius

Payers reporting HCPCS A4690

Payer pricing summary

Low

Average

$307

Median

$115

High

$1.5k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Humana fee schedule · outpatient · +8 other terms	71	$1.5k	$2.4k	$1.5k	65%	—	$198 – $4.3k
2	Blue Cross Blue Shield facility · fee schedule · outpatient · +9 other terms	35	$494	$2.1k	$2.8k	133%	—	$0 – $11.4k
3	Aetna fee schedule · outpatient · +9 other terms	29	$470	$623	$576	93%	—	$225 – $3.1k
4	UnitedHealthcare fee schedule · both · +11 other terms	26	$258	$497	$306	62%	—	$257 – $1.2k
5	Anthem facility · case rate · outpatient · +8 other terms	15	$10	$11	$3	23%	—	$7 – $17
6	Caresource facility · case rate · outpatient · +4 other terms	15	$10	$11	$3	23%	—	$7 – $17
7	Cigna fee schedule · both · +7 other terms	15	$1.0k	$924	$198	21%	—	$399 – $1.0k
8	Molina facility · case rate · outpatient · +4 other terms	15	$10	$11	$3	23%	—	$7 – $17
9	Medical Mutual facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms	13	$25	$28	$11	38%	—	$10 – $49
10	Wellmark fee schedule · both · +1 other terms	13	$748	$737	$69	9%	—	$318 – $748
11	Optum facility · case rate · outpatient · +2 other terms	11	$10	$10	$2	22%	—	$9 – $15
12	Highmark fee schedule · outpatient · +5 other terms	10	$61	$61	—	—	—	$61 – $61
13	Medica fee schedule · outpatient · +4 other terms	10	$891	$893	$229	26%	—	$540 – $1.2k
14	Ucare fee schedule · both	9	$44	$45	$2	5%	—	$42 – $47
15	Bcbs Mn fee schedule · both · +2 other terms	8	$47	$47	—	—	—	$47 – $47
16	Aetna Better Health fee schedule · inpatient · +3 other terms	7	$204	$204	—	—	—	$204 – $204
17	Ambetter facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms	3	$29	$26	$5	19%	—	$18 – $30
18	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$116	$120	$7	6%	—	$115 – $130
19	First Health professional · fee schedule · both · +3 other terms	3	$269	$269	—	—	—	$269 – $269
20	Kaiser fee schedule · both · +1 other terms	2	$1.8k	$1.8k	—	—	—	$1.8k – $1.8k
21	Tricare facility · fee schedule · outpatient	2	$128	$95	$39	41%	—	$46 – $173
22	WellCare facility · percent of total billed charges · outpatientfrom % of charges	2	$13	$13	$3	22%	—	$10 – $17
23	Bcbs Id facility · fee schedule · outpatient · +1 other terms	1	$70	$70	—	—	—	$70 – $70
24	Bcbs Il professional · fee schedule · both	1	$318	$318	—	—	—	$318 – $318
25	Bcbs La facility · fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0

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