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South Dakota 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
Professional
Modifier
Low / Median / High Price
$13.99 / $60.75 / $75.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.37 / $3.38 / $5.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.07 / $33.02 / $58.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.51 / $5.51 / $5.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.57 / $31.88 / $58.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.61 / $4.61 / $4.61