| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $911.27 | $1,455.97 | $7,031.78 | |
Moda Health
| Professional | $1,117.29 | $1,117.29 | $1,117.29 | |
Providence
| Facility | $911.27 | $1,455.97 | $7,031.78 | |
Providence
| Professional | $1,117.29 | $1,117.29 | $1,117.29 |