| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $138.44 | $360.05 | $440.64 | |
Moda Health
| Professional | $201.39 | $201.39 | $201.39 | |
Providence
| Facility | $138.44 | $360.05 | $440.64 | |
Providence
| Professional | $201.39 | $201.39 | $201.39 |