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Utah rates for HCPCS A4707

Bicarbonate concentrate, powder, for hemodialysis, per packet

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.40 / $4.40 / $4.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $4.40 / $5.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00