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Michigan rates for HCPCS A4680

Activated carbon filter for hemodialysis, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.60 / $32.60 / $32.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.54 / $32.60 / $42.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.00 / $48.27 / $98.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.10 / $18.89 / $22.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.29 / $36.29 / $63.82
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.60 / $43.20 / $47.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.36 / $43.20 / $56.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $75.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.57 / $27.15 / $47.06