go back

New Jersey 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
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.13 / $14.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $23.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $39.81 / $61.66