| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,454.71 | $2,454.71 | $2,454.71 | |
Medcost
| Facility | $2,454.71 | $3,630.78 | $4,265.80 | |
Molina
| Professional | $83.18 | $87.10 | $2,089.30 |
Restorigin, 1 cc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,454.71 | $2,454.71 | $2,454.71 | |
Medcost
| Facility | $2,454.71 | $3,630.78 | $4,265.80 | |
Molina
| Professional | $83.18 | $87.10 | $2,089.30 |