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Pennsylvania 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
$2.51 / $2.51 / $2.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $66.07 / $66.07
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
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $35.48 / $61.66