| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $50.00 | $70.72 | $105.33 | |
Premera BCBS
| Facility | $3,495.87 | $3,495.87 | $3,495.87 | |
Providence
| Facility | $3,495.87 | $3,495.87 | $3,495.87 | |
Providence
| Professional | $50.00 | $70.72 | $105.33 |