| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $6.00 | $6.00 | $6.00 | |
Cigna
| Professional | $19.80 | $19.80 | $19.80 |
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 | |
Cigna
| Professional | $19.80 | $19.80 | $19.80 |