| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $330.73 | $330.73 | $330.73 | |
Providence
| Facility | $162.46 | $475.15 | $490.19 |
Thorcom Thrc W/Medstnl & Regional Lmphadec
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $330.73 | $330.73 | $330.73 | |
Providence
| Facility | $162.46 | $475.15 | $490.19 |