go back

Maine rates for HCPCS A4765

Dialysate Conc Pow Per Pack

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $5.45 / $5.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.34 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.37
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $5.45 / $5.45