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Virginia 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
$35.00 / $35.00 / $35.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $12.38 / $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 / $59.40
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $57.75
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $4,071.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $4,071.00