| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $553.66 | $553.66 | $553.66 | |
Cigna
| Professional | $553.66 | $553.66 | $553.66 | |
Providence
| Facility | $304.16 | $380.20 | $553.66 | |
Providence
| Professional | $553.66 | $553.66 | $553.66 | |
United
| Professional | $526.76 | $587.54 | $648.30 |