| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $2,079.82 | $2,968.08 | $3,532.09 | |
Moda Health
| Professional | $2,650.09 | $2,650.09 | $2,650.09 | |
Pacific Source
| Facility | $1,768.91 | $2,244.66 | $2,460.77 | |
Providence
| Facility | $2,079.82 | $2,968.08 | $3,532.09 | |
Providence
| Professional | $2,650.09 | $2,650.09 | $2,650.09 |