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Idaho 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 / $13.99
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.06 / $2.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $55.00 / $3,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.02 / $34.79 / $52.00