| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $254.40 | $439.37 | $535.91 | |
Moda Health
| Professional | $419.24 | $419.24 | $419.24 | |
Providence
| Facility | $254.40 | $439.37 | $535.91 | |
Providence
| Professional | $419.24 | $419.24 | $419.24 |