| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $54.95 | $56.23 | $1,445.44 | |
Lucent Health
| Professional | $5,495.41 | $5,495.41 | $5,495.41 | |
Moda Health
| Facility | $436.52 | $562.34 | $1,412.54 | |
Providence
| Facility | $436.52 | $575.44 | $1,412.54 |