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Montana 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
$21.00 / $35.00 / $35.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $53.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.78 / $2,250,000.00