| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $293.00 | $293.00 | $3,239.00 |
Split Agrft T/A/L Ea 100 Cm/Ea 1% Bdy Inft/Chld
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $293.00 | $293.00 | $3,239.00 |