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Montana 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 $21 · 10th–90th $20–$420%50%10th90th$21Professionalmedian $20 · 10th–90th $20–$200%50%$20$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $19.95
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $21.38 / $41.69
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $85.11