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Texas 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

Facilitymedian $19 · 10th–90th $19–$420%20%40%90th$19Professionalmedian $19 · 10th–90th $19–$190%50%90th$19$1.0$2.0$5.0$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $19.50 / $19.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $19.05 / $19.50
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $19.50 / $19.50
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $19.50 / $38.02
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $19.05 / $19.50
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $19.50 / $38.02
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $79.43
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.48 / $11.48 / $14.13