| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,507.20 | $3,013.22 | $16,467.00 | |
Medcost
| Facility | $1,147.25 | $1,748.04 | $2,469.33 | |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |
Plmt Prox Xtn Prosth Evasc Rpr Dta 1st Xtn
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,507.20 | $3,013.22 | $16,467.00 | |
Medcost
| Facility | $1,147.25 | $1,748.04 | $2,469.33 | |
United
| Facility | $659.00 | $6,107.00 | $8,818.00 |