| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $891.25 | $891.25 | $891.25 | |
Molina
| Professional | $60.26 | $85.11 | $199.53 | |
Providence
| Facility | $891.25 | $891.25 | $891.25 | |
United
| Facility | $794.33 | $1,737.80 | $1,737.80 |