| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $223.87 | $223.87 | $457.09 | |
Moda Health
| Professional | $380.19 | $380.19 | $380.19 | |
Providence
| Facility | $223.87 | $416.87 | $831.76 | |
Providence
| Professional | $380.19 | $380.19 | $380.19 |