| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,480.00 | $2,480.00 | $2,480.00 | |
Providence
| Facility | $3,112.50 | $3,112.50 | $3,112.50 | |
Providence
| Professional | $2,988.00 | $2,988.00 | $2,250,000.00 |
Restorigin, 1 cc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,480.00 | $2,480.00 | $2,480.00 | |
Providence
| Facility | $3,112.50 | $3,112.50 | $3,112.50 | |
Providence
| Professional | $2,988.00 | $2,988.00 | $2,250,000.00 |