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Arkansas rates for HCPCS A4726

Dialysate Solution Any Concentration Of Dextrose Fluid Volume Greater Than 5999cc For Peritoneal Dialysis (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $35.00 / $35.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149,999.85 / $399,999.60 / $999,999.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.86 / $30.26 / $33.61