| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $647.96 | $647.96 | $936.29 | |
Cigna
| Professional | $647.96 | $936.29 | $936.29 | |
Providence
| Facility | $553.91 | $738.56 | $936.29 | |
Providence
| Professional | $647.96 | $936.29 | $936.29 | |
United
| Professional | $361.96 | $379.17 | $631.95 |