| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.05 | $19.05 | $44.67 | |
Aetna
| Professional | $16.22 | $19.05 | $19.05 | |
Molina
| Professional | $32.36 | $33.11 | $75.86 |
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
| Facility | $19.05 | $19.05 | $44.67 | |
Aetna
| Professional | $16.22 | $19.05 | $19.05 | |
Molina
| Professional | $32.36 | $33.11 | $75.86 |