| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
MVP Health Care
| Professional | $275.42 | $275.42 | $275.42 | |
MVP Health Care
| Professional | 26 | $74.13 | $74.13 | $74.13 |
United
| Professional | $91.20 | $165.96 | $263.03 | |
United
| Professional | 26 | $19.50 | $25.70 | $46.77 |
United
| Professional | TC | $67.61 | $91.20 | $223.87 |