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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
$128,319.99 / $130,939.99 / $152,349.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $40.74
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $4.65 / $7.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $13.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.00 / $37.00 / $283.26
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
$9.44 / $9.44 / $9.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $70.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $50.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.39 / $35.08 / $70.02