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Georgia 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
Professional
Modifier
Low / Median / High Price
$1.90 / $2.00 / $2.00
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
$58.00 / $58.00 / $58.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.23 / $15.23 / $15.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.79 / $35.01 / $59.25