| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $445.50 | $445.50 | $445.50 |
Impltj/Rplcmt Ithcl/Edrl Drug Nfs Prgrbl Pump
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $445.50 | $445.50 | $445.50 |