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Utah rates for HCPCS A4890

Contracts, Repair and Maintenance, for Home Dialysis Equipment (Non-Co

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.60 / $17.60 / $17.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.60 / $254.94 / $622.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00