| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $442.72 | $442.72 | $442.72 | |
Providence
| Facility | $218.80 | $300.85 | $442.72 |
Optx&/Rdctj Vrt Fx&/Dislc Pst 1 Vrt Sgm Ea
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $442.72 | $442.72 | $442.72 | |
Providence
| Facility | $218.80 | $300.85 | $442.72 |