| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $287.61 | $287.61 | $8,500.00 | |
Medica
| Facility | $287.61 | $355.78 | $862.83 |
Dlyd Placement Xtn Prosth For Evasc Rpr Ea Addl
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $287.61 | $287.61 | $8,500.00 | |
Medica
| Facility | $287.61 | $355.78 | $862.83 |