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Texas 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 / $5.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $6.03 / $6.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.50 / $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
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.62 / $281.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $79.43
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.85