| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13,639.39 | $13,639.39 | $104,028.88 | |
CareSource
| Facility | $419.61 | $475.01 | $517.54 | |
Cigna
| Facility | $450.53 | $450.53 | $450.53 |
Rmvl Impltbl Dfb Pls Gen W/Rplcmt Pls Gen Mlt Ld
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13,639.39 | $13,639.39 | $104,028.88 | |
CareSource
| Facility | $419.61 | $475.01 | $517.54 | |
Cigna
| Facility | $450.53 | $450.53 | $450.53 |