| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $186.21 | $295.12 | $331.13 | |
Moda Health
| Professional | $288.40 | $288.40 | $288.40 | |
Providence
| Facility | $190.55 | $295.12 | $363.08 | |
Providence
| Professional | $288.40 | $288.40 | $288.40 |