| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $2.51 | $199.53 | $346.74 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $1.66 | $1.66 | $1.66 | |
United
| Facility | $1.62 | $1.62 | $1.62 | |
United
| Professional | $1.62 | $1.62 | $1.70 |