| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $164.23 | $660.98 | $660.98 | |
Medcost
| Facility | $859.27 | $859.27 | $859.27 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Hemostatic Agent, Gi, Topic
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $164.23 | $660.98 | $660.98 | |
Medcost
| Facility | $859.27 | $859.27 | $859.27 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |