| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $34.67 | $34.67 | $34.67 | |
Aetna
| Professional | $34.67 | $34.67 | $34.67 | |
Molina
| Professional | $30.20 | $44.67 | $60.26 | |
Select Health
| Professional | $1.82 | $1.82 | $1.82 |
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
| Facility | $34.67 | $34.67 | $34.67 | |
Aetna
| Professional | $34.67 | $34.67 | $34.67 | |
Molina
| Professional | $30.20 | $44.67 | $60.26 | |
Select Health
| Professional | $1.82 | $1.82 | $1.82 |