| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $398.38 | $398.38 | $8,500.00 | |
Medica
| Facility | $398.38 | $480.93 | $1,195.14 |
Rmvl Impltbl Dfb Pls Gen W/Rplcmt Pls Gen Mlt Ld
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $398.38 | $398.38 | $8,500.00 | |
Medica
| Facility | $398.38 | $480.93 | $1,195.14 |