| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $144.54 | $269.15 | $346.74 | |
Moda Health
| Professional | $295.12 | $295.12 | $295.12 | |
Providence
| Facility | $144.54 | $275.42 | $316.23 | |
Providence
| Professional | $295.12 | $295.12 | $295.12 |