| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,949.00 | $3,949.00 | $6,907.00 |
Repair Intermediate N/H/F/Xtrnl Gent 12.6-20 Cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3,949.00 | $3,949.00 | $6,907.00 |