| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $810.61 | $810.61 | $8,500.00 | |
Medica
| Facility | $673.05 | $810.61 | $2,431.83 |
Expl Po Hemrrg Thrombosis/Infctj Xtr
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $810.61 | $810.61 | $8,500.00 | |
Medica
| Facility | $673.05 | $810.61 | $2,431.83 |