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South Carolina 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
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.47 / $7.66
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.40 / $7.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $7.00 / $7.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.24 / $31.95 / $43.91