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Michigan 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $0.89 / $0.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.89 / $0.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $2.63
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $2.63