| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,618.10 | $4,618.10 | $4,618.10 | |
Providence
| Facility | $2,268.94 | $5,125.89 | $5,482.51 |
Rescj/Exc Les Itprl Fossa Space Apex Idrl W/Rpr
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $4,618.10 | $4,618.10 | $4,618.10 | |
Providence
| Facility | $2,268.94 | $5,125.89 | $5,482.51 |