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New Hampshire rates for HCPCS A4714

Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon

Facilitymedian $5 · 10th–90th $3–$60%20%10th90th$5Professionalmedian $2 · 10th–90th $2–$60%50%90th$2$2.0$5.0$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $16.98 / $16.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $36.31 / $64.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $36.31 / $63.10
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.16 / $4.90 / $6.31