| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $128.44 | $207.65 | $1,400.00 | |
CareSource
| Facility | $130.69 | $156.84 | $170.88 | |
Cigna
| Facility | $219.66 | $219.66 | $219.66 |
Simple Repair F/E/E/N/L/M 12.6cm-20.0 Cm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $128.44 | $207.65 | $1,400.00 | |
CareSource
| Facility | $130.69 | $156.84 | $170.88 | |
Cigna
| Facility | $219.66 | $219.66 | $219.66 |