| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $123.76 | $563.05 | $746.03 | |
Moda Health
| Professional | $560.16 | $560.16 | $560.16 | |
Providence
| Facility | $123.76 | $563.05 | $746.03 | |
Providence
| Professional | $560.16 | $560.16 | $560.16 |