| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $285.00 | $285.00 | $285.00 | |
Aetna
| Professional | $5.45 | $5.45 | $5.45 | |
Moda Health
| Facility | $5.45 | $5.72 | $11.72 | |
Molina
| Professional | $30.00 | $30.00 | $3,500.00 |
Dialysate concentrate, powder, additive for peritoneal dialysis, per packet
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $285.00 | $285.00 | $285.00 | |
Aetna
| Professional | $5.45 | $5.45 | $5.45 | |
Moda Health
| Facility | $5.45 | $5.72 | $11.72 | |
Molina
| Professional | $30.00 | $30.00 | $3,500.00 |