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Michigan 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 $4–$200%50%10th$20Professionalmedian $20 · 10th–90th $15–$200%50%10th$20$2.0$5.0$10.0$20.0$50.0

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
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.37 / $5.37 / $5.37
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.37 / $5.37 / $5.62
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.72 / $3.98 / $19.95
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $19.95 / $19.95