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California rates for HCPCS A4721

Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis

Facilitymedian $20 · 10th–90th $20–$380%50%90th$20Professionalmedian $20 · 10th–90th $20–$400%50%90th$20$0.0$0.2$2.0$20.0$200.0

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
$19.95 / $19.95 / $19.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $19.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $14.13 / $30.20
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $39.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $398.11 / $831.76
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
$38.90 / $38.90 / $38.90
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $34.67
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $14.13