| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $813.13 | $813.13 | $10,000.00 | |
Medica
| Facility | $813.13 | $1,204.07 | $1,433.21 |
Rcnstj Coltrl Ligm Mtcarphlngl 1 W/Tdn/Fscal Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $813.13 | $813.13 | $10,000.00 | |
Medica
| Facility | $813.13 | $1,204.07 | $1,433.21 |