| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $102.33 | $141.25 | $194.98 | |
Moda Health
| Professional | $169.82 | $169.82 | $169.82 | |
Providence
| Facility | $102.33 | $151.36 | $194.98 | |
Providence
| Professional | $169.82 | $169.82 | $169.82 |