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Arizona rates for HCPCS A4726

Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis

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
$20.00 / $34.00 / $34.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.50 / $20.00 / $23.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $56.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.24 / $82.24 / $82.24