| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $19.95 | $19.95 | $19.95 | |
Providence
| Facility | $19.95 | $19.95 | $36.31 | |
Providence
| Professional | $79.43 | $79.43 | $85.11 |
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 | $19.95 | $19.95 | $19.95 | |
Providence
| Facility | $19.95 | $19.95 | $36.31 | |
Providence
| Professional | $79.43 | $79.43 | $85.11 |