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Dialysate, over 3999 to 4999 cc, for Peritoneal Dialysis

Idaho rates for HCPCS A4724

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

Rates data updated July 2026.

Facilitymedian $19 · 10th–90th $19$1200%20%40%10th90th$19Professionalmedian $19 · 10th–90th $4$200%50%10th90th$19$5.0$20.0$100.0$500.0$2.0K$10.0K

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
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$4.07
Median
$18.62
Typical High
$20.42
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$7.24
Median
$18.62
Typical High
$120.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Select Health
Setting
Professional
Modifier
Global
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$8,511.38