| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,809.52 | $5,809.52 | $5,810.23 | |
Martin's Point
| Facility | $5,809.52 | $5,809.52 | $5,810.23 |
Rmvl Impltbl Dfb Pls Gen W/Rplcmt Pls Gen Mlt Ld
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5,809.52 | $5,809.52 | $5,810.23 | |
Martin's Point
| Facility | $5,809.52 | $5,809.52 | $5,810.23 |