| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $14.92 | $21.55 | $109.60 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Hally Health
| Professional | $17.51 | $17.64 | $19.27 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |