| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $1,949.84 | $1,949.84 | $1,949.84 | |
Moda Health
| Professional | $1,905.46 | $1,905.46 | $1,905.46 | |
Providence
| Facility | $1,445.44 | $1,819.70 | $2,570.40 | |
Providence
| Professional | $1,905.46 | $1,905.46 | $1,905.46 |