| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,044.57 | $1,044.57 | $8,500.00 | |
Medica
| Facility | $1,044.57 | $1,300.15 | $1,775.18 |
Optx Pst/Ant Actblr Wall Fx W/Int Fixj
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,044.57 | $1,044.57 | $8,500.00 | |
Medica
| Facility | $1,044.57 | $1,300.15 | $1,775.18 |