| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $83.18 | $131.83 | $158.49 | |
Moda Health
| Professional | $114.82 | $114.82 | $114.82 | |
Providence
| Facility | $83.18 | $134.90 | $158.49 | |
Providence
| Professional | $114.82 | $114.82 | $114.82 |