| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $302.00 | $457.09 | $549.54 | |
Moda Health
| Professional | $467.74 | $467.74 | $467.74 | |
Pacific Source
| Facility | $1,318.26 | $1,318.26 | $1,318.26 | |
Providence
| Facility | $302.00 | $457.09 | $549.54 | |
Providence
| Professional | $467.74 | $467.74 | $467.74 |