| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $0.55 | $275.42 | $676.08 | |
Moda Health
| Professional | $645.65 | $645.65 | $645.65 | |
Providence
| Facility | $134.90 | $478.63 | $691.83 | |
Providence
| Professional | $645.65 | $645.65 | $645.65 |