go back

Michigan 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
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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.89 / $50.68 / $103.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.96 / $19.85 / $23.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.74 / $26.74 / $26.74
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $35.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.10 / $35.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $75.00