| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $12.00 | $20.00 | $20.00 | |
Providence
| Facility | $20.00 | $20.00 | $30.80 | |
Providence
| Professional | $1.36 | $1.41 | $2,400,000.00 |
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 | $12.00 | $20.00 | $20.00 | |
Providence
| Facility | $20.00 | $20.00 | $30.80 | |
Providence
| Professional | $1.36 | $1.41 | $2,400,000.00 |