go back

Mississippi 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
Professional
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $2,400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250.00 / $2,250.00 / $2,250.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $21.25 / $50.00