| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $371.54 | $2,630.27 | $2,630.27 | |
Lucent Health
| Professional | $371.54 | $371.54 | $371.54 | |
Providence
| Professional | $1.82 | $1.82 | $1.82 | |
United
| Professional | $50.12 | $66.07 | $112.20 |