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Washington, DC 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
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $77.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.00 / $29.00 / $29.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.24 / $42.83 / $58.80