| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $590.77 | $590.77 | $590.77 | |
Cigna
| Professional | $590.77 | $590.77 | $590.77 | |
Providence
| Facility | $590.77 | $590.77 | $590.77 | |
Providence
| Professional | $366.69 | $366.69 | $590.77 | |
United
| Professional | $103.54 | $103.54 | $246.52 |