| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $3,304.55 | $3,304.55 | $3,304.55 | |
Cigna
| Professional | $3,304.55 | $3,304.55 | $3,304.55 | |
Providence
| Facility | $3,304.55 | $3,304.55 | $3,304.55 | |
Providence
| Professional | $2,051.10 | $2,051.10 | $3,304.55 | |
United
| Professional | $957.18 | $957.18 | $2,279.00 |