| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $35.00 | $35.00 | $35.00 | |
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
Moda Health
| Facility | $35.00 | $35.70 | $44.80 | |
Molina
| Professional | $30.00 | $30.00 | $3,500.00 |
Dialysate Solution Any Concentration Of Dextrose Fluid Volume Greater Than 5999cc For Peritoneal Dialysis (Special Coverage Instructions Apply. See Mcm: 4270)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $35.00 | $35.00 | $35.00 | |
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
Moda Health
| Facility | $35.00 | $35.70 | $44.80 | |
Molina
| Professional | $30.00 | $30.00 | $3,500.00 |