| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $4,897.79 | $4,897.79 | $4,897.79 | |
Moda Health
| Professional | $4,897.79 | $14,791.08 | $14,791.08 | |
Premera BCBS
| Professional | $4,466.84 | $11,220.18 | $11,220.18 | |
Providence
| Facility | $1,995.26 | $1,995.26 | $1,995.26 | |
United
| Professional | $1,513.56 | $5,011.87 | $7,585.78 |