| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $833.40 | $833.40 | $833.40 | |
Cigna
| Professional | $106.49 | $833.40 | $1,200.98 | |
Providence
| Facility | $777.78 | $1,144.44 | $1,921.57 | |
Providence
| Professional | $106.49 | $833.40 | $1,200.98 | |
United
| Professional | $612.50 | $668.58 | $1,114.30 |