| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $95.40 | $421.49 | $554.42 | |
Moda Health
| Professional | $418.30 | $418.30 | $418.30 | |
Providence
| Facility | $95.40 | $421.49 | $554.42 | |
Providence
| Professional | $418.30 | $418.30 | $418.30 |