| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $120.23 | $199.53 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
United
| Facility | $2,884.03 | $2,884.03 | $5,370.32 | |
United
| Professional | $112.20 | $158.49 | $251.19 |