| 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 | |
Cigna
| Professional | $15.84 | $15.84 | $15.84 | |
United
| Professional | $25.25 | $25.25 | $25.25 |
Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis
| 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 | |
Cigna
| Professional | $15.84 | $15.84 | $15.84 | |
United
| Professional | $25.25 | $25.25 | $25.25 |