| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $117.71 | $117.71 | $147.13 | |
Pacific Source
| Facility | $93.26 | $93.26 | $93.26 | |
Providence
| Facility | $111.91 | $111.91 | $111.91 | |
Providence
| Professional | $83.93 | $102.59 | $128.69 |