| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $4,786.30 | $4,786.30 | $4,786.30 | |
Lucent Health
| Professional | $4,786.30 | $4,786.30 | $4,786.30 | |
United
| Facility | $549.54 | $1,122.02 | $1,905.46 | |
United
| Professional | $616.60 | $933.25 | $1,258.93 |