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Pennsylvania rates for HCPCS A4707

Bicarbonate conc pow per pac

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.14 / $5.14 / $5.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.40 / $5.14 / $5.14
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.29 / $5.29 / $5.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.18 / $4.18 / $4.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.40 / $5.14 / $5.14
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.18 / $4.18 / $4.18