| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $55.00 | $55.00 | $5,682.77 | |
Lucent Health
| Professional | $15,682.00 | $15,682.00 | $15,682.00 | |
Moda Health
| Facility | $1,566.74 | $2,020.05 | $3,543.84 | |
Oscar Health
| Professional | $2,257.10 | $2,257.10 | $2,257.10 | |
Providence
| Facility | $1,566.74 | $2,020.05 | $3,543.84 |