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Pennsylvania 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 $25 · 10th–90th $20–$250%50%10th$25Professionalmedian $20 · 10th–90th $20–$200%50%$20$1.0$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
$25.12 / $25.12 / $25.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $19.95
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $7.41
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.90 / $4.90 / $4.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $19.95
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $30.20