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Michigan 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
Facility
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.30 / $16.89 / $34.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.98 / $6.62 / $7.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.24 / $9.24 / $15.44
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $75.00