| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $100.00 | $100.00 | $1,288.04 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,250,000.00 | |
Wellpoint
| Professional | $750.00 | $750.00 | $750.00 |
Unspecified Restorative Procedure, By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $100.00 | $100.00 | $1,288.04 | |
Providence
| Professional | $2,250,000.00 | $2,250,000.00 | $2,250,000.00 | |
Wellpoint
| Professional | $750.00 | $750.00 | $750.00 |