| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5,128.61 | $5,128.61 | $5,128.61 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 |
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 | $5,128.61 | |
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 |