| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $21.00 | $35.00 | $35.00 | |
Providence
| Facility | $35.00 | $35.00 | $53.90 | |
Providence
| Professional | $0.37 | $0.39 | $2,400,000.00 |
Dialysate Solution Any Concentration Of Dextrose Fluid Volume Greater Than 4999cc But Less Than Or Equal To 5999cc For Peritoneal Dialysis (Special Coverage Instructions Apply. See Mcm: 4270)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $21.00 | $35.00 | $35.00 | |
Providence
| Facility | $35.00 | $35.00 | $53.90 | |
Providence
| Professional | $0.37 | $0.39 | $2,400,000.00 |