| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $5,104.00 | $5,104.00 | $5,104.00 | |
Cigna
| Professional | $4,044.92 | $5,056.14 | $5,104.00 | |
Providence
| Facility | $5,104.00 | $5,104.00 | $5,104.00 | |
Providence
| Professional | $3,168.00 | $3,520.00 | $5,104.00 | |
United
| Professional | $1,478.40 | $1,478.40 | $3,520.00 |