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Montana rates for HCPCS A4724

Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc, but less than or equal to 4999 cc

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $18.41 / $119.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.05 / $18.41 / $130.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00