| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $55.00 | $55.00 | $2,812.02 | |
Lucent Health
| Professional | $4,309.00 | $4,309.00 | $4,309.00 | |
Moda Health
| Facility | $805.81 | $1,042.45 | $2,494.80 | |
Oscar Health
| Professional | $997.90 | $997.90 | $997.90 | |
Providence
| Facility | $805.81 | $1,042.45 | $2,494.80 |