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Washington rates for HCPCS A4706

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $6.00 / $13.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.29 / $40.00 / $46.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $15.00