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Indiana rates for HCPCS A4765

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $5.45 / $285.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.00 / $2.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.64 / $2.64 / $4.37