| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $19.67 | $19.67 | $19.67 | |
Cigna
| Professional | $17.12 | $17.12 | $17.12 |
Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $19.67 | $19.67 | $19.67 | |
Cigna
| Professional | $17.12 | $17.12 | $17.12 |