| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $121.08 | $336.03 | $497.34 | |
Moda Health
| Professional | $182.50 | $182.50 | $182.50 | |
Providence
| Facility | $121.08 | $336.03 | $483.89 | |
Providence
| Professional | $182.50 | $182.50 | $182.50 |