| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.01 | $5.01 | $281.84 | |
Medica
| Facility | $5.50 | $8.51 | $281.84 | |
Medica
| Professional | $6.03 | $6.03 | $6.03 |
Dialysate concentrate, powder, additive for peritoneal dialysis, per packet
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.01 | $5.01 | $281.84 | |
Medica
| Facility | $5.50 | $8.51 | $281.84 | |
Medica
| Professional | $6.03 | $6.03 | $6.03 |