| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $111.88 | $201.18 | $201.18 | |
Lucent Health
| Professional | $500.00 | $500.00 | $500.00 | |
Moda Health
| Professional | $43.77 | $43.77 | $72.37 | |
Oscar Health
| Professional | $44.50 | $44.50 | $53.10 | |
Providence
| Facility | $58.00 | $58.00 | $70.00 | |
United
| Professional | $60.00 | $60.00 | $60.00 |