| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $349.35 | $415.77 | $997.90 | |
Moda Health
| Professional | $370.61 | $370.61 | $370.61 | |
Providence
| Facility | $349.35 | $415.77 | $997.90 | |
Providence
| Professional | $370.61 | $370.61 | $370.61 |