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Virginia 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–$340%50%10th90th$20Professionalmedian $20 · 10th–90th $9–$200%50%10th$20$0.0$0.2$2.0$20.0$200.0$2.0K

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
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $15.49
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $20.42 / $33.88
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $4,073.80 / $4,073.80
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $4,073.80 / $4,073.80