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Montana rates for HCPCS A4690

Dialyzer (Artificial Kidneys) All Types All Sizes For Hemodialysis Each (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.67 / $323.83 / $455.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.75 / $687.75 / $687.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.63 / $359.63 / $687.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.26 / $579.38 / $803.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.63 / $687.75 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.19 / $283.23 / $283.23