| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,121.46 | $1,401.88 | $6,500.00 | |
Medica
| Facility | $1,121.46 | $1,628.60 | $2,343.06 |
Capsul Midfoot W/Pst Talotibl Capsul&Tdn Lngth
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,121.46 | $1,401.88 | $6,500.00 | |
Medica
| Facility | $1,121.46 | $1,628.60 | $2,343.06 |