| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $209,761.51 | $209,761.51 | $209,761.51 | |
Providence
| Facility | $75,396.86 | $75,396.86 | $209,761.51 |
Organic Disturbances&Mental Retardation
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $209,761.51 | $209,761.51 | $209,761.51 | |
Providence
| Facility | $75,396.86 | $75,396.86 | $209,761.51 |