| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.94 | $18.41 | $18.41 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |
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 | $5.94 | $18.41 | $18.41 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |