| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $134.66 | $311.22 | $315.00 | |
Lucent Health
| Professional | $603.00 | $603.00 | $603.00 | |
Moda Health
| Facility | $76.39 | $124.58 | $195.08 | |
Providence
| Facility | $76.39 | $124.93 | $195.08 | |
Providence
| Professional | $71.61 | $71.61 | $71.61 |