| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $131.83 | $131.83 | $131.83 | |
Medica
| Professional | $223.87 | $223.87 | $223.87 | |
United
| Facility | $104.71 | $1,047.13 | $2,951.21 | |
United
| Professional | $45.71 | $45.71 | $117.49 |