| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
Hally Health
| Professional | $18.16 | $18.84 | $24.26 | |
Medica
| Facility | $35.00 | $35.00 | $59.15 |
Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
Hally Health
| Professional | $18.16 | $18.84 | $24.26 | |
Medica
| Facility | $35.00 | $35.00 | $59.15 |