| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $42.00 | $168.00 | $248.00 |
Daily Hosp Mgmt Edrl/Sarach Cont Drug Admn
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $42.00 | $168.00 | $248.00 |