| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $3.98 | $18.20 | $18.20 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
Medcost
| Facility | $18.62 | $19.50 | $38.90 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |
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 | $3.98 | $18.20 | $18.20 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
Medcost
| Facility | $18.62 | $19.50 | $38.90 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |