| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $432.60 | $2,090.73 | $3,955.04 | |
United
| Facility | $540.00 | $1,401.00 | $4,915.00 |
Simple Repair F/E/E/N/L/M 12.6cm-20.0 Cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $432.60 | $2,090.73 | $3,955.04 | |
United
| Facility | $540.00 | $1,401.00 | $4,915.00 |