| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $129.11 | $129.11 | $456.00 |
Sgmdsc Flx W/Dcmprn W/Plmt Dcmprn Tube
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $129.11 | $129.11 | $456.00 |