| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $117.56 | $117.56 | $699.00 |
Bx Lvr Ndl Done Purpose Tm Oth Major Px
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $117.56 | $117.56 | $699.00 |