| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $667.54 | $923.04 | $1,243.34 | |
Moda Health
| Professional | $1,054.77 | $1,054.77 | $1,054.77 | |
Providence
| Facility | $677.04 | $923.04 | $1,243.34 | |
Providence
| Professional | $1,054.77 | $1,054.77 | $1,054.77 |