| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $4,298.18 | $5,149.72 | $5,866.47 | |
Health Alliance Plan
| Facility | $1,198.70 | $1,198.70 | $1,477.84 | |
Health Alliance Plan
| Professional | $1,198.70 | $1,321.48 | $2,113.38 |