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Montana rates for HCPCS A4706

Bicarbonate concentrate, solution, for hemodialysis, per gallon

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $6.00 / $6.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.65 / $5.65 / $5.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $9.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00