| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $305.82 | $778.41 | $778.41 | |
Lucent Health
| Professional | $1,012.00 | $1,012.00 | $1,012.00 | |
Moda Health
| Facility | $165.53 | $220.60 | $308.75 | |
Providence
| Facility | $165.53 | $220.68 | $310.55 | |
Providence
| Professional | $149.66 | $149.66 | $149.66 |