| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $165.92 | $165.92 | $165.92 | |
Cigna
| Professional | $165.92 | $165.92 | $165.92 | |
Providence
| Facility | $165.92 | $165.92 | $165.92 | |
Providence
| Professional | $102.99 | $102.99 | $165.92 | |
United
| Professional | $48.06 | $48.06 | $114.43 |