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Pennsylvania rates for HCPCS A4913

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

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
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
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.19 / $310.19 / $310.19
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.88
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.99