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Ohio 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
$6.58 / $6.58 / $6.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $35.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $32.40 / $49.17
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
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $2.70 / $2.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00