| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,892.79 | $1,892.79 | $1,892.79 | |
Cigna
| Professional | $1,892.79 | $1,892.79 | $1,892.79 | |
Providence
| Facility | $1,892.79 | $1,892.79 | $1,892.79 | |
Providence
| Professional | $1,174.83 | $1,174.83 | $1,892.79 | |
United
| Professional | $548.26 | $548.26 | $1,305.36 |