| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $451.14 | $451.14 | $451.14 | |
Providence
| Facility | $451.14 | $451.14 | $451.14 |
Dlyd Placement Xtn Prosth For Evasc Rpr Ea Addl
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $451.14 | $451.14 | $451.14 | |
Providence
| Facility | $451.14 | $451.14 | $451.14 |