| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $180.13 | $180.13 | $180.13 | |
Cigna
| Professional | $180.13 | $180.13 | $185.53 | |
Providence
| Facility | $180.13 | $180.13 | $180.13 | |
Providence
| Professional | $180.13 | $180.13 | $185.53 |