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New York 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
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $12.82 / $20.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.40 / $59.40 / $2,250.00
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.40 / $59.40 / $2,250.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20