| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $1,683.81 | $1,683.81 | $1,683.81 | |
Lucent Health
| Professional | $1,683.81 | $1,965.24 | $1,965.24 | |
Moda Health
| Facility | $500.24 | $680.57 | $1,003.89 | |
Providence
| Facility | $500.24 | $680.57 | $1,195.93 |