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Texas rates for HCPCS A4722

Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis

Facilitymedian $35 · 10th–90th $35–$740%50%90th$35Professionalmedian $35 · 10th–90th $35–$350%50%$35$1.0$2.0$5.0$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
$34.67 / $34.67 / $34.67
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $34.67
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
$41.69 / $53.70 / $53.70
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $69.18
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $34.67
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $34.67 / $69.18
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
$15.49 / $15.49 / $15.49
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $17.38