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Pennsylvania rates for HCPCS A4721

Dialysat sol fld vol > 999cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.13 / $6.13 / $7.35
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.33 / $28.33 / $28.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
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
$28.33 / $28.33 / $28.33