| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $175.88 | $175.88 | $219.84 | |
Lucent Health
| Facility | $747.98 | $20,243.40 | $20,243.40 | |
Lucent Health
| Professional | $1,434.97 | $1,434.97 | $1,434.97 | |
Moda Health
| Professional | $5,306.00 | $5,306.00 | $6,634.00 |