| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $6.00 | $6.00 | $6.00 | |
Hally Health
| Professional | $53.77 | $55.80 | $71.83 | |
Medica
| Facility | $6.00 | $6.00 | $10.14 |
Bicarbonate Concentrate Solution For Hemodialysis Per Gallon (Special Coverage Instructions Apply. See Mcm: 4270)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $6.00 | $6.00 | $6.00 | |
Hally Health
| Professional | $53.77 | $55.80 | $71.83 | |
Medica
| Facility | $6.00 | $6.00 | $10.14 |