| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CDPHP
| Facility | $128.30 | $128.30 | $128.30 | |
CDPHP
| Professional | $128.30 | $128.30 | $128.30 | |
MVP Health Care
| Professional | $248.50 | $248.50 | $248.50 | |
United
| Professional | $85.00 | $85.00 | $85.00 |