| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $19.05 | $19.05 | $19.05 | |
Molina
| Professional | $44.67 | $60.26 | $70.79 | |
Providence
| Facility | $15.14 | $19.50 | $25.12 |
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 | $19.05 | $19.05 | $19.05 | |
Molina
| Professional | $44.67 | $60.26 | $70.79 | |
Providence
| Facility | $15.14 | $19.50 | $25.12 |