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Vermont 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 / $13.99 / $77.15
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.99 / $13.99 / $77.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.57 / $51.34 / $126.45