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New Jersey 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
$34.67 / $34.67 / $34.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38,018.94 / $38,018.94 / $38,018.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $22.91 / $25.12