| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $218.84 | $218.84 | $1,400.00 | |
CareSource
| Facility | $225.22 | $259.32 | $282.54 | |
Cigna
| Facility | $242.04 | $242.04 | $242.04 | |
Cigna
| Facility | AS | $23.45 | $23.45 | $23.45 |
Thorcom Thrc W/Medstnl & Regional Lmphadec
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $218.84 | $218.84 | $1,400.00 | |
CareSource
| Facility | $225.22 | $259.32 | $282.54 | |
Cigna
| Facility | $242.04 | $242.04 | $242.04 | |
Cigna
| Facility | AS | $23.45 | $23.45 | $23.45 |