| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.10 | $63.10 | $63.10 |
Freestanding Clinic-Visit by RHC/FQHC Practitioner to a Member in a SNF (Not in a Covered Part A Stay) or NF or ICF MR or Other Residential Facility
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $63.10 | $63.10 | $63.10 |