| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $2,817.65 | $2,817.65 | $2,817.65 | |
Cigna
| Professional | $2,817.65 | $2,817.65 | $2,817.65 | |
Providence
| Facility | $2,817.65 | $2,817.65 | $2,817.65 | |
Providence
| Professional | $1,748.89 | $1,748.89 | $2,817.65 | |
United
| Professional | $816.15 | $816.15 | $1,943.21 |