| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,120.10 | $5,120.10 | $5,120.10 | |
Providence
| Professional | $1,800,000.00 | $2,250,000.00 | $2,400,000.00 |
SurFactor or NuDyn, per 0.5 cc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,120.10 | $5,120.10 | $5,120.10 | |
Providence
| Professional | $1,800,000.00 | $2,250,000.00 | $2,400,000.00 |