| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,120.10 | $5,120.10 | $5,120.10 | |
Medica
| Facility | $5,120.10 | $8,652.99 | $14,029.10 |
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 | |
Medica
| Facility | $5,120.10 | $8,652.99 | $14,029.10 |