| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $331.13 | $331.13 | $331.13 | |
Medica
| Professional | $776.25 | $776.25 | $776.25 | |
United
| Facility | $40.74 | $3,388.44 | $6,760.83 | |
United
| Professional | $42.66 | $42.66 | $42.66 |