| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $786.15 | $786.15 | $8,500.00 | |
Medica
| Facility | $786.15 | $1,001.71 | $2,358.44 |
Revj Opn Arven Fstl W/Thrmbc Dial Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $786.15 | $786.15 | $8,500.00 | |
Medica
| Facility | $786.15 | $1,001.71 | $2,358.44 |