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Illinois rates for HCPCS A4755

Blood Tubing Arterial And Venous Combined For Hemodialysis Each (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
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 / $10.84 / $10.84
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.87 / $138.37 / $160.00
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