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Montana 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

Facilitymedian $19 · 10th–90th $5–$1910%20%40%10th90th$19Professionalmedian $18 · 10th–90th $4–$1200%50%10th90th$18$5.0$10.0$20.0$50.0$100.0$200.0

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
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $18.20 / $120.23
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.13 / $19.50 / $190.55
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $85.11