| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | 26 | $106.21 | $106.21 | $131.30 |
Providence
| Facility | 26 | $106.21 | $106.21 | $131.30 |
Card Bl Pool Plnr Mlt Stdy Wal Motn Eject Fract
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | 26 | $106.21 | $106.21 | $131.30 |
Providence
| Facility | 26 | $106.21 | $106.21 | $131.30 |