| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $133.86 | $622.79 | $687.56 | |
Moda Health
| Professional | $643.15 | $643.15 | $643.15 | |
Providence
| Facility | $133.86 | $596.85 | $687.56 | |
Providence
| Professional | $643.15 | $643.15 | $643.15 |