| 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 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 | $21.00 | $35.00 | $35.00 | |
Providence
| Facility | $35.00 | $35.00 | $53.90 | |
Providence
| Professional | $0.37 | $0.39 | $2,400,000.00 |