| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,920.78 | $9,774.00 | $14,772.57 | |
Moda Health
| Facility | $812.46 | $3,240.81 | $4,634.35 | |
Providence
| Facility | $812.46 | $3,240.81 | $4,634.35 |
Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,920.78 | $9,774.00 | $14,772.57 | |
Moda Health
| Facility | $812.46 | $3,240.81 | $4,634.35 | |
Providence
| Facility | $812.46 | $3,240.81 | $4,634.35 |