| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CDPHP
| Facility | $142.63 | $142.63 | $142.63 | |
CDPHP
| Professional | $104.12 | $142.63 | $142.63 | |
Cigna
| Professional | $173.71 | $173.71 | $208.13 | |
MVP Health Care
| Professional | $142.63 | $142.63 | $296.98 |