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California rates for HCPCS A4765

Dialysate concentrate, powder, additive for peritoneal dialysis, per packet

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114,815.36 / $138,038.43 / $588,843.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.66 / $2.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $4.68 / $7.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $281.84 / $831.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.50 / $239.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67