| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CDPHP
| Facility | $178.16 | $178.16 | $178.16 | |
CDPHP
| Professional | $178.16 | $178.16 | $178.16 | |
Cigna
| Professional | $200.51 | $200.51 | $250.63 | |
MVP Health Care
| Professional | $200.51 | $200.51 | $250.63 |