| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $2,480.00 | $2,480.00 | $2,480.00 | |
Sentara
| Facility | $100.00 | $1,750.00 | $10,945.00 | |
Sentara
| Professional | $100.00 | $1,750.00 | $10,945.00 |
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 | |
Sentara
| Facility | $100.00 | $1,750.00 | $10,945.00 | |
Sentara
| Professional | $100.00 | $1,750.00 | $10,945.00 |