| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $80.02 | $80.02 | $80.02 | |
Aetna
| Professional | $116.60 | $116.60 | $116.60 | |
MVP Health Care
| Facility | $555.00 | $597.00 | $74,999.25 | |
MVP Health Care
| Professional | $50.00 | $50.00 | $50.00 |