| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $177.72 | $177.72 | $177.72 | |
Providence
| Facility | $109.46 | $192.71 | $266.27 |
Sgmdsc Flx W/Dcmprn W/Plmt Dcmprn Tube
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $177.72 | $177.72 | $177.72 | |
Providence
| Facility | $109.46 | $192.71 | $266.27 |