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Illinois 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–$1000%20%40%90th$20Professionalmedian $20 · 10th–90th $20–$200%50%$20$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. 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
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $39.81
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $125.89 / $346.74
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $2,511.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $44.67 / $38,018.94