| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2.40 | $2.40 | $2.40 | |
Aetna
| Professional | $2.40 | $2.97 | $4.21 | |
Cigna
| Professional | $3.57 | $3.57 | $3.57 | |
United
| Professional | $1.97 | $3.96 | $4.92 |
Gravlee Jet Washer (Special Coverage Instructions Apply. See Cim: 50-4 And Mcm: 2320)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2.40 | $2.40 | $2.40 | |
Aetna
| Professional | $2.40 | $2.97 | $4.21 | |
Cigna
| Professional | $3.57 | $3.57 | $3.57 | |
United
| Professional | $1.97 | $3.96 | $4.92 |