| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $4.05 | $18.41 | $119.00 | |
BCBS
| Facility | $6.40 | $10.88 | $10.88 | |
BCBS
| Professional | $7.00 | $8.00 | $9.30 | |
Medica
| Facility | $18.41 | $119.00 | $142.80 |
Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $4.05 | $18.41 | $119.00 | |
BCBS
| Facility | $6.40 | $10.88 | $10.88 | |
BCBS
| Professional | $7.00 | $8.00 | $9.30 | |
Medica
| Facility | $18.41 | $119.00 | $142.80 |