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Ohio rates for HCPCS A4765

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.44 / $9.44 / $9.44
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
$1.80 / $2.16 / $3.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.37
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00