| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $2,528.73 | $2,528.73 | $2,528.73 | |
Cigna
| Professional | $2,528.73 | $2,528.73 | $2,528.73 | |
Providence
| Facility | $2,528.73 | $2,528.73 | $2,528.73 | |
Providence
| Professional | $1,569.56 | $1,569.56 | $2,528.73 | |
United
| Professional | $469.55 | $469.55 | $1,117.98 |