| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CDPHP
| Facility | $177.83 | $177.83 | $177.83 | |
CDPHP
| Professional | $128.82 | $177.83 | $177.83 | |
Cigna
| Professional | $208.93 | $208.93 | $245.47 | |
United
| Professional | $74.13 | $104.71 | $177.83 |