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South Carolina 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
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.65 / $15.24 / $15.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $10.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00