| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $446.68 | $691.83 | $1,023.29 | |
Moda Health
| Professional | $933.25 | $933.25 | $933.25 | |
Providence
| Facility | $436.52 | $691.83 | $1,023.29 | |
Providence
| Professional | $933.25 | $933.25 | $933.25 |