| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $323.59 | $794.33 | $1,000.00 | |
Moda Health
| Professional | $870.96 | $870.96 | $870.96 | |
Providence
| Facility | $323.59 | $794.33 | $933.25 | |
Providence
| Professional | $870.96 | $870.96 | $870.96 |