| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $7,939.04 | $7,939.04 | $7,939.04 | |
Cigna
| Professional | $7,939.04 | $7,939.04 | $7,939.04 | |
Providence
| Facility | $7,939.04 | $7,939.04 | $7,939.04 | |
Providence
| Professional | $4,927.68 | $4,927.68 | $7,939.04 | |
United
| Professional | $2,299.58 | $2,299.58 | $5,475.20 |