| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
Medica
| Facility | $58.91 | $59.15 | $95.90 | |
Sanford Health Plan
| Professional | $1.06 | $1.06 | $1.06 |
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 | |
Medica
| Facility | $58.91 | $59.15 | $95.90 | |
Sanford Health Plan
| Professional | $1.06 | $1.06 | $1.06 |