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Virginia 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
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.30
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.00 / $29.00 / $32.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.38
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.90 / $100.00 / $4,071.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.90 / $100.00 / $4,071.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.40 / $39.04 / $71.39