| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $1,578.77 | $2,091.57 | $2,771.25 | |
Moda Health
| Professional | $2,067.83 | $2,067.83 | $2,067.83 | |
Providence
| Facility | $1,578.77 | $2,091.57 | $2,771.25 | |
Providence
| Professional | $2,067.83 | $2,067.83 | $2,067.83 |