| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $25.05 | $25.05 | $200.00 | |
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 | $25.05 | $25.05 | $2,250,000.00 |