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Mississippi 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
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.13 / $14.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $25.12 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $30.20 / $52.48