| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CDPHP
| Facility | $23.48 | $23.48 | $32.84 | |
CDPHP
| Professional | $23.48 | $32.84 | $56.32 | |
Cigna
| Professional | $64.02 | $83.29 | $128.38 | |
MVP Health Care
| Facility | $105.94 | $153.97 | $254.50 | |
MVP Health Care
| Professional | $64.02 | $83.29 | $128.38 |