| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $55.00 | $55.00 | $6,265.25 | |
Lucent Health
| Facility | AS | $346.51 | $626.53 | $626.53 |
Providence
| Facility | $3,892.34 | $3,892.34 | $3,892.34 | |
Providence
| Facility | AS | $492.86 | $492.86 | $492.86 |