| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $6,165.95 | $6,165.95 | $6,165.95 | |
Medica
| Professional | $15,135.61 | $15,135.61 | $15,135.61 | |
United
| Facility | $229.09 | $1,047.13 | $2,951.21 | |
United
| Professional | $2,951.21 | $3,715.35 | $4,786.30 |