| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $22.81 | $58.74 | $109.65 | |
Moda Health
| Professional | $23.62 | $23.62 | $23.62 | |
Pacific Source
| Facility | $21.44 | $71.25 | $83.75 | |
Providence
| Facility | $22.81 | $58.74 | $109.65 | |
Providence
| Professional | $23.62 | $23.62 | $23.62 |