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Arizona rates for HCPCS A4706

Bicarbonate Concentrate Solution For Hemodialysis Per Gallon (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.60 / $67.31 / $67.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.32 / $49.50 / $57.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.55 / $5.65 / $5.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $9.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.11 / $21.11 / $21.11