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New Mexico rates for HCPCS A4706

Bicarbonate concentrate, solution, for hemodialysis, per gallon

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $15.14 / $70.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $9.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $21.38 / $21.38