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Texas rates for HCPCS A4706

Bicarbonate concentrate, solution, for hemodialysis, per gallon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.40 / $5.40 / $5.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.24 / $15.24 / $15.24
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.11 / $21.11 / $21.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $12.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $12.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $21.00