| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $127.71 | $143.32 | $164.00 | |
Moda Health
| Professional | $129.47 | $129.47 | $129.47 | |
Providence
| Facility | $127.71 | $143.32 | $164.00 | |
Providence
| Professional | $129.47 | $129.47 | $129.47 |