| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $35.00 | $35.00 | $35.00 | |
Medica
| Facility | $35.00 | $35.00 | $40.25 | |
Medica
| Professional | $82.24 | $82.24 | $82.24 |
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
| Professional | $35.00 | $35.00 | $35.00 | |
Medica
| Facility | $35.00 | $35.00 | $40.25 | |
Medica
| Professional | $82.24 | $82.24 | $82.24 |