| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $2,137.96 | $2,951.21 | $3,715.35 | |
Moda Health
| Professional | $3,090.30 | $3,090.30 | $3,090.30 | |
Providence
| Facility | $2,238.72 | $3,019.95 | $4,168.69 | |
Providence
| Professional | $3,090.30 | $3,090.30 | $3,090.30 |