| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $169.60 | $310.00 | $382.27 | |
Moda Health
| Professional | $297.91 | $297.91 | $297.91 | |
Providence
| Facility | $169.60 | $310.00 | $382.27 | |
Providence
| Professional | $297.91 | $297.91 | $297.91 |