| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,128.61 | $5,128.61 | $6,606.93 | |
Providence
| Facility | $5,128.61 | $5,623.41 | $8,709.64 | |
Providence
| Professional | $79.43 | $79.43 | $85.11 |
SurFactor or NuDyn, per 0.5 cc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,128.61 | $5,128.61 | $6,606.93 | |
Providence
| Facility | $5,128.61 | $5,623.41 | $8,709.64 | |
Providence
| Professional | $79.43 | $79.43 | $85.11 |