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Texas 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
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.80 / $52.80 / $52.80
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.44 / $9.44 / $120.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $4.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $4.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $13.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.24 / $33.02 / $61.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.80