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Ohio rates for HCPCS A4765

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

Facilitymedian $10 · 10th–90th $10–$100%50%$10Professionalmedian $5 · 10th–90th $2–$50%50%10th90th$5$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.00 / $10.00 / $10.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $6.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.29 / $3.47
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $50.12 / $60.26
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $60.26 / $75.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $83.18