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Minnesota 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.10 / $1.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.07 / $1.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.74 / $164.02 / $465.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.75 / $65.00 / $77.15
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.52 / $153.59 / $366.53
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.75 / $60.75 / $69.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.39 / $33.35 / $59.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.64 / $31.88 / $59.96