| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.81 | $5.81 | $5.81 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |
Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.81 | $5.81 | $5.81 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |