| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $217.80 | $217.80 | $217.80 | |
Moda Health
| Professional | $210.68 | $210.68 | $210.68 | |
Providence
| Facility | $217.80 | $217.80 | $217.80 | |
Providence
| Professional | $210.68 | $210.68 | $210.68 |