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New Mexico 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
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $13.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $70.00 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $52.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $2,250,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.24 / $35.08 / $58.43