| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $488.00 | $488.00 | |
Medcost
| Facility | $156.00 | $187.50 | $1,950.00 | |
Wellcare
| Facility | $180.00 | $180.00 | $180.00 |
Daily Hosp Mgmt Edrl/Sarach Cont Drug Admn
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.00 | $488.00 | $488.00 | |
Medcost
| Facility | $156.00 | $187.50 | $1,950.00 | |
Wellcare
| Facility | $180.00 | $180.00 | $180.00 |