| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $2,569.13 | $2,569.13 | $2,569.13 | |
Cigna
| Professional | $295.60 | $295.60 | $2,569.13 | |
Providence
| Facility | $260.39 | $402.16 | $2,569.13 | |
Providence
| Professional | $295.60 | $295.60 | $2,569.13 | |
United
| Professional | $163.99 | $177.36 | $203.03 |