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South Carolina rates for HCPCS A4765

Dialysate Conc Pow Per Pack

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $5.45 / $5.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.16 / $3.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.37
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.45 / $5.45 / $11.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00