| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $116.20 | $500.62 | $659.95 | |
Moda Health
| Professional | $496.95 | $496.95 | $496.95 | |
Providence
| Facility | $116.20 | $500.62 | $659.95 | |
Providence
| Professional | $496.95 | $496.95 | $496.95 |