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North Dakota 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 / $60.75 / $77.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.07 / $32.14 / $59.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.57 / $29.54 / $58.14