| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $20.00 | $20.00 | $20.00 | |
Anthem BCBS
| Professional | $14.25 | $14.25 | $30.00 | |
Medica
| Facility | $20.00 | $21.74 | $44.49 | |
Medica
| Professional | $39.22 | $39.22 | $39.22 |
Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $20.00 | $20.00 | $20.00 | |
Anthem BCBS
| Professional | $14.25 | $14.25 | $30.00 | |
Medica
| Facility | $20.00 | $21.74 | $44.49 | |
Medica
| Professional | $39.22 | $39.22 | $39.22 |