| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $549.54 | $794.33 | $1,174.90 | |
Moda Health
| Professional | $1,047.13 | $1,047.13 | $1,047.13 | |
Providence
| Facility | $575.44 | $794.33 | $1,174.90 | |
Providence
| Professional | $1,047.13 | $1,047.13 | $1,047.13 |