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Texas 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–$430%50%90th$20Professionalmedian $20 · 10th–90th $20–$200%50%$20$10.0$20.0$50.0$100.0

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
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
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
$30.20 / $38.90 / $38.90
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $39.81
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $19.95
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $39.81
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $79.43
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $14.13
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $13.49