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Connecticut rates for HCPCS A4714

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $2.00 / $44.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $13.99
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64,999.35 / $64,999.35 / $64,999.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.42 / $39.04 / $62.20