| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $359.59 | $359.59 | $359.59 | |
Cigna
| Professional | $94.09 | $359.59 | $1,089.00 | |
Providence
| Facility | $72.47 | $359.59 | $992.70 | |
Providence
| Professional | $94.09 | $359.59 | $1,089.00 | |
United
| Professional | $461.06 | $576.86 | $576.86 |