| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.20 | $125.20 | $125.20 | |
Aetna
| Professional | $55.00 | $87.43 | $125.20 | |
Cigna
| Professional | $118.80 | $118.80 | $118.80 |
Work Related/Med Dblt Xm Treating Phys
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.20 | $125.20 | $125.20 | |
Aetna
| Professional | $55.00 | $87.43 | $125.20 | |
Cigna
| Professional | $118.80 | $118.80 | $118.80 |