| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $3,574.39 | $3,574.39 | $3,574.39 | |
Providence
| Facility | $2,098.09 | $2,957.94 | $4,099.87 |
Gstrct Tot W/Roux-En-Y Rcnstj
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $3,574.39 | $3,574.39 | $3,574.39 | |
Providence
| Facility | $2,098.09 | $2,957.94 | $4,099.87 |