| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $4.05 | $18.41 | $18.41 | |
Cigna
| Professional | $39.60 | $39.60 | $39.60 |
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 | $18.41 | |
Cigna
| Professional | $39.60 | $39.60 | $39.60 |