| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $660.69 | $660.69 | $660.69 | |
Medcost
| Facility | $660.69 | $954.99 | $1,122.02 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |
Hemostatic agent, gastrointestinal, topical
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $660.69 | $660.69 | $660.69 | |
Medcost
| Facility | $660.69 | $954.99 | $1,122.02 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 |