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Idaho rates for HCPCS A4765

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $9.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.62 / $281.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20