| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $422.45 | $500.50 | $1,063.10 | |
Moda Health
| Professional | $453.22 | $453.22 | $453.22 | |
Providence
| Facility | $422.45 | $500.50 | $1,063.10 | |
Providence
| Professional | $453.22 | $453.22 | $453.22 |