| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $81.59 | $81.59 | $81.59 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 | |
Providence
| Facility | $134.15 | $160.78 | $380.72 | |
Providence
| Professional | $81.59 | $160.78 | $160.78 |