| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $345.10 | $416.43 | $996.77 | |
Moda Health
| Professional | $379.03 | $379.03 | $379.03 | |
Providence
| Facility | $345.10 | $416.43 | $996.77 | |
Providence
| Professional | $379.03 | $379.03 | $379.03 |