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Minnesota 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $35.45 / $35.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.18 / $34.39 / $35.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $59.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.24 / $82.24 / $82.24