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Nationwide rates for HCPCS A4722

Dialysate Solution Any Concentration Of Dextrose Fluid Volume Greater Than 1999cc But Less Than Or Equal To 2999cc For Peritoneal Dialysis (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $35.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $35.00 / $35.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.28 / $71.28 / $71.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.65 / $18.79 / $30.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.47 / $38.47 / $38.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.50 / $45.00 / $72.05