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Oregon rates for HCPCS A4720

Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $19.67 / $19.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $178.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.67 / $19.67 / $36.19
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.67 / $19.67 / $42.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,400,000.00