| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $133.50 | $211.09 | $8,500.00 | |
Medica
| Facility | $133.50 | $226.95 | $486.07 |
Split Agrft F/S/N/H/F/G/M/D Gt Ea 100 Cm/Ea 1 %
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $133.50 | $211.09 | $8,500.00 | |
Medica
| Facility | $133.50 | $226.95 | $486.07 |