| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $830.27 | $830.27 | $830.27 | |
Health Alliance Plan
| Professional | $7.42 | $7.42 | $7.42 | |
Molina
| Professional | $30.00 | $30.00 | $100.00 | |
United
| Facility | $292.92 | $671.45 | $1,131.10 |