| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $64.00 | $196.40 | $320.00 | |
Lucent Health
| Professional | $291.00 | $320.00 | $320.00 | |
Moda Health
| Facility | $18.23 | $24.42 | $33.96 | |
Providence
| Facility | $18.23 | $24.42 | $33.96 |