| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
CDPHP
| Facility | $5.94 | $5.94 | $6.53 | |
CDPHP
| Professional | $5.94 | $5.94 | $5.94 | |
MVP Health Care
| Facility | $555.00 | $597.00 | $74,999.25 | |
MVP Health Care
| Professional | $1.25 | $1.25 | $1.25 | |
Univera
| Facility | $1.21 | $1.21 | $1.21 | |
Univera
| Professional | $1.17 | $1.17 | $1.21 |