| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $289.45 | $289.45 | $611.00 |
Colsc Flx W/Ndsc Us Xm Rctm Et Al Lmtd&Adj Strux
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $289.45 | $289.45 | $611.00 |