| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4.00 | $4.00 | $4.00 | |
Aetna
| Professional | $4.00 | $4.00 | $4.00 | |
Moda Health
| Facility | $4.00 | $4.08 | $5.12 | |
Molina
| Professional | $30.00 | $30.00 | $3,900.00 |
Y Set Tubing For Peritoneal Dialysis (Special Coverage Instructions Apply. See Mcm: 4270)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4.00 | $4.00 | $4.00 | |
Aetna
| Professional | $4.00 | $4.00 | $4.00 | |
Moda Health
| Facility | $4.00 | $4.08 | $5.12 | |
Molina
| Professional | $30.00 | $30.00 | $3,900.00 |