| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $46.67 | $77.22 | $109.22 | |
Moda Health
| Professional | $82.47 | $82.47 | $82.47 | |
Providence
| Facility | $46.67 | $80.00 | $109.22 | |
Providence
| Professional | $82.47 | $82.47 | $82.47 |