| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $457.09 | $1,905.46 | $3,801.89 | |
Moda Health
| Professional | $645.65 | $645.65 | $645.65 | |
Providence
| Facility | $501.19 | $851.14 | $3,801.89 | |
Providence
| Professional | $645.65 | $645.65 | $645.65 |