| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $268.16 | $407.83 | $8,500.00 | |
Medica
| Facility | $268.16 | $407.83 | $804.48 |
Repair Intermediate N/H/F/Xtrnl Gent 12.6-20 Cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $268.16 | $407.83 | $8,500.00 | |
Medica
| Facility | $268.16 | $407.83 | $804.48 |