| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $90.78 | $90.78 | $206.97 |
Intro Mix Saline&Air F/Ssg Conf Occls Flp Tube
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $90.78 | $90.78 | $206.97 |