| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $3,879.88 | $3,879.88 | $3,879.88 | |
Providence
| Facility | $1,889.04 | $4,001.40 | $4,328.20 |
Rescj/Exc Les Base Ant Crnl Fossa Indrl W/Wo Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $3,879.88 | $3,879.88 | $3,879.88 | |
Providence
| Facility | $1,889.04 | $4,001.40 | $4,328.20 |