| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,006.63 | $1,006.63 | $22,379.94 | |
Martin's Point
| Facility | $22,379.94 | $22,379.94 | $22,379.94 |
Revj Incl Rplcmt Nstim Eltrd Plt/Pdle Incl Fluor
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,006.63 | $1,006.63 | $22,379.94 | |
Martin's Point
| Facility | $22,379.94 | $22,379.94 | $22,379.94 |