| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CDPHP
| Facility | $614.61 | $614.61 | $614.61 | |
CDPHP
| Professional | $614.61 | $614.61 | $614.61 | |
Excellus BCBS
| Professional | $426.99 | $602.05 | $1,065.31 | |
Univera
| Facility | $427.09 | $427.09 | $427.09 | |
Univera
| Professional | $363.03 | $427.09 | $1,065.31 |