| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $366.10 | $593.69 | $715.49 | |
Moda Health
| Professional | $562.76 | $562.76 | $562.76 | |
Providence
| Facility | $366.10 | $593.69 | $715.49 | |
Providence
| Professional | $562.76 | $562.76 | $562.76 |