| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Capital Blue Cross
| Facility | $967.00 | $967.00 | $967.00 |
PolyCyte, for topical use only, per 0.5 cc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Capital Blue Cross
| Facility | $967.00 | $967.00 | $967.00 |