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California rates for HCPCS A4724

Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc, but less than or equal to 4999 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.05 / $4.05 / $4.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.05 / $18.41 / $18.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $25.50 / $30.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.77 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $70.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.05 / $18.41 / $23.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,400,000.00 / $2,400,000.00