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Wisconsin rates for HCPCS A4714

Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon

Facilitymedian $2 · 10th–90th $2–$1700%50%90th$2Professionalmedian $2 · 10th–90th $2–$330%50%90th$2$1.0$5.0$20.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $2.95 / $46.77
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $169.82 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $67.61 / $77.62
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.40
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.79 / $5.37 / $7.08
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $33.11 / $56.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $54.95 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $14.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $33.11 / $58.88