| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $594.36 | $594.36 | $594.36 | |
Cigna
| Professional | $594.36 | $594.36 | $594.36 | |
Providence
| Facility | $594.36 | $594.36 | $594.36 | |
Providence
| Professional | $368.91 | $368.91 | $594.36 | |
United
| Professional | $172.16 | $172.16 | $409.90 |