| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $100.00 | $199.53 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
United
| Facility | $6.92 | $23.44 | $37.15 | |
United
| Professional | $25.12 | $34.67 | $52.48 |