| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,101.03 | $1,101.03 | $1,101.03 | |
Providence
| Facility | $1,101.03 | $1,322.10 | $1,370.63 |
Rmvl I-Aort Balo Asst Dev W/Rpr Fem Art W/Wo Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,101.03 | $1,101.03 | $1,101.03 | |
Providence
| Facility | $1,101.03 | $1,322.10 | $1,370.63 |