| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $489.78 | $602.56 | $1,023.29 | |
Lucent Health
| Facility | $1,071.52 | $1,071.52 | $1,071.52 | |
Lucent Health
| Professional | $1,479.11 | $1,479.11 | $1,621.81 | |
Moda Health
| Facility | $112.20 | $229.09 | $524.81 | |
Providence
| Facility | $177.83 | $398.11 | $660.69 |