| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $9,896.54 | $26,542.00 | $26,542.00 | |
Lucent Health
| Professional | $6,050.73 | $6,050.73 | $6,050.73 | |
Moda Health
| Facility | $1,309.90 | $1,669.62 | $2,177.42 | |
Oscar Health
| Professional | $1,578.10 | $1,578.10 | $1,578.10 | |
Providence
| Facility | $1,309.90 | $1,669.62 | $2,260.98 |