| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $338.42 | $627.45 | $627.45 | |
Lucent Health
| Professional | $648.24 | $648.24 | $648.24 | |
Moda Health
| Facility | $93.17 | $139.00 | $254.55 | |
Providence
| Facility | $93.17 | $139.00 | $254.55 | |
Providence
| Professional | $170.12 | $170.12 | $170.12 |