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Illinois rates for HCPCS A4719

Y Set Tubing For Peritoneal Dialysis (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.62 / $136.62 / $136.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.00 / $46.00 / $46.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.24 / $16.44 / $16.44
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.43 / $13.16 / $15.19
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $2,500.00