| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $217.60 | $254.16 | $537.38 | |
Moda Health
| Professional | $231.55 | $231.55 | $231.55 | |
Providence
| Facility | $217.60 | $254.16 | $537.38 | |
Providence
| Professional | $231.55 | $231.55 | $231.55 |