go back

California rates for HCPCS A4766

Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.01 / $25.50 / $30.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $2.70 / $2.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.77 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.74 / $3.74 / $3.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $70.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.80 / $8.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,400,000.00 / $2,400,000.00