| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $213.80 | $213.80 | $213.80 | |
Lucent Health
| Professional | $251.19 | $251.19 | $354.81 | |
Moda Health
| Facility | $38.90 | $38.90 | $87.10 | |
Providence
| Facility | $47.86 | $72.44 | $114.82 |