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Illinois rates for HCPCS A4913

Miscellaneous Dialysis Supplies Not Otherwise Specified (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.88 / $32.67 / $43.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.19 / $310.19 / $310.19
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $125.00 / $345.40
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
$1,500.00 / $2,500.00 / $2,500.00