| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $1,613.85 | $1,613.85 | $1,933.58 | |
Pacific Source
| Facility | $1,097.33 | $1,371.67 | $13,251.51 | |
Pacific Source
| Professional | $12,549.35 | $12,549.35 | $13,251.51 | |
Providence
| Professional | $1,175.42 | $1,567.22 | $3,070.39 |