| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $109.65 | $138.04 | $177.83 | |
Moda Health
| Professional | $128.82 | $128.82 | $128.82 | |
Providence
| Facility | $112.20 | $141.25 | $204.17 | |
Providence
| Professional | $128.82 | $128.82 | $128.82 |