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California rates for HCPCS A4714

Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138,038.43 / $151,356.12 / $151,356.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $2.00 / $43.65
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $4.68 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.13 / $14.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $34.67 / $52.48
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
$9.33 / $9.33 / $9.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $4.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $16.98 / $16.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $35.48 / $63.10