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California rates for HCPCS A4726

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $35.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $35.00 / $35.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $20.26 / $20.26
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.84 / $15.84 / $59.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.77 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.24 / $82.24 / $82.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $70.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $50.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.78 / $2,400,000.00