| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $208.24 | $365.49 | $459.61 | |
Moda Health
| Professional | $287.60 | $287.60 | $287.60 | |
Providence
| Facility | $208.24 | $339.30 | $459.61 | |
Providence
| Professional | $287.60 | $287.60 | $287.60 |