| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $29,649.00 | $29,649.00 | $95,816.00 |
Ins/Rplcmnt Perm Subq Impltbl Dfb W/Subq Eltrd
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $29,649.00 | $29,649.00 | $95,816.00 |