| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.25 | $220.00 | $331.00 | |
Hometown Health
| Professional | $194.08 | $260.00 | $320.25 |
Daily Hosp Mgmt Edrl/Sarach Cont Drug Admn
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $21.25 | $220.00 | $331.00 | |
Hometown Health
| Professional | $194.08 | $260.00 | $320.25 |