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Dialysate, over 249 to 999 cc, for Peritoneal Dialysis

Pennsylvania 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

Rates data updated October 2026.

How much does Dialysate, over 249 to 999 cc, for Peritoneal Dialysis cost?

$4.07

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $4.07 for this service. The price depends on where it is billed: about $4.07 from a physician practice, and about $4.07 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$4.07$4.07 to $19.50
FacilityA hospital or hospital-owned outpatient department$4.07$4.07 to $19.50

How much rates vary

Facilitymedian $4 · 10th to 90th $4 to $5,012Professionalmedian $4 · 10th to 90th $4 to $19
$10$100$1K$10K$100Kfacility $4professional $4

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$19.50
Median
$19.50
Typical High
$19.50
Aetna
Setting
Professional
Modifier
None
Typical Low
$19.50
Median
$19.50
Typical High
$19.50
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$9.77
Median
$9.77
Typical High
$9.77
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$3.89
Median
$3.89
Typical High
$3.89
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$2.95
Median
$2.95
Typical High
$2.95
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$1.95
Median
$1.95
Typical High
$1.95
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$3.63
Median
$4.07
Typical High
$5,011.87
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$3.72
Median
$4.07
Typical High
$4.07
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$19.50
Median
$19.50
Typical High
$19.50
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$19.50
Median
$19.50
Typical High
$19.50
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$9.77
Median
$9.77
Typical High
$9.77
Martin's Point
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$3.89
Median
$3.89
Typical High
$3.89
Martin's Point
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$2.95
Median
$2.95
Typical High
$2.95
Martin's Point
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$1.95
Median
$1.95
Typical High
$1.95
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$0.60
Median
$0.60
Typical High
$0.60

Where Pennsylvania sits

The same service costs 22.4 times more in Montana than in Kansas. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 50th of 51

$4.07

MT $79.43KS $3.55

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.