| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
CareFirst
| Professional | $10.00 | $10.00 | $10.00 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $34.69 | $34.69 | $46.74 |
Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
CareFirst
| Professional | $10.00 | $10.00 | $10.00 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $34.69 | $34.69 | $46.74 |