| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $104,069.89 | $104,069.89 | $109,385.55 |
Organic Disturbances&Mental Retardation
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $104,069.89 | $104,069.89 | $109,385.55 |