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Missouri 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
$1.00 / $1.02 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $13.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.20 / $4.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.64 / $33.64 / $58.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.57 / $33.42 / $49.45