| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
Anthem BCBS
| Professional | $18.79 | $18.79 | $30.00 | |
Medica
| Facility | $35.00 | $38.04 | $77.84 | |
Medica
| Professional | $53.27 | $53.27 | $53.27 |
Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
Anthem BCBS
| Professional | $18.79 | $18.79 | $30.00 | |
Medica
| Facility | $35.00 | $38.04 | $77.84 | |
Medica
| Professional | $53.27 | $53.27 | $53.27 |