| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $65.00 | $255.78 | $350.00 | |
Lucent Health
| Professional | $228.75 | $258.29 | $258.29 | |
Moda Health
| Facility | $45.26 | $60.70 | $85.89 | |
Providence
| Facility | $45.26 | $60.70 | $85.89 |