| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $688.25 | $975.04 | $6,500.00 | |
Medica
| Facility | $688.25 | $952.40 | $4,713.68 |
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 | $688.25 | $975.04 | $6,500.00 | |
Medica
| Facility | $688.25 | $952.40 | $4,713.68 |