| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $759.82 | $1,396.26 | $1,717.85 | |
Moda Health
| Professional | $1,422.17 | $1,422.17 | $1,422.17 | |
Providence
| Facility | $759.82 | $1,324.80 | $1,717.85 | |
Providence
| Professional | $1,422.17 | $1,422.17 | $1,422.17 |