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Dialysate, over 3999 to 4999 cc, for Peritoneal Dialysis

Oklahoma 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 October 2026.

How much rates vary

Facilitymedian $19 · 10th to 90th $19 to $26Professionalmedian $19 · 10th to 90th $19 to $19
$5$10$20$50$100facility $19professional $19

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Aetna
Setting
Professional
Modifier
None
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$3.72
Median
$3.72
Typical High
$3.72
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$2.75
Median
$2.75
Typical High
$2.75
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
Medica
Setting
Facility
Modifier
None
Typical Low
$18.62
Median
$18.62
Typical High
$26.30