| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $149.41 | $407.10 | $572.90 | |
Moda Health
| Professional | $211.70 | $211.70 | $211.70 | |
Providence
| Facility | $149.41 | $407.10 | $572.90 | |
Providence
| Professional | $211.70 | $211.70 | $211.70 |