| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $400.00 | $400.00 | $400.00 | |
Aetna
| Professional | $87.57 | $333.33 | $400.00 | |
Cigna
| Professional | $105.60 | $105.60 | $105.60 |
Work Related/Med Dblt Xm Oth/Thn Treating Phys
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $400.00 | $400.00 | $400.00 | |
Aetna
| Professional | $87.57 | $333.33 | $400.00 | |
Cigna
| Professional | $105.60 | $105.60 | $105.60 |