| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $843.67 | $843.67 | $2,300.00 | |
CareSource
| Facility | $843.72 | $967.22 | $1,053.80 | |
Cigna
| Facility | $907.02 | $907.02 | $907.02 | |
Cigna
| Facility | AS | $88.40 | $88.40 | $88.40 |
Revj Opn Arven Fstl W/Thrmbc Dial Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $843.67 | $843.67 | $2,300.00 | |
CareSource
| Facility | $843.72 | $967.22 | $1,053.80 | |
Cigna
| Facility | $907.02 | $907.02 | $907.02 | |
Cigna
| Facility | AS | $88.40 | $88.40 | $88.40 |