| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $90.00 | $90.00 | $90.00 | |
Midlands
| Facility | $63.68 | $63.68 | $63.68 | |
Midlands
| Professional | $63.68 | $63.68 | $63.68 |
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $90.00 | $90.00 | $90.00 | |
Midlands
| Facility | $63.68 | $63.68 | $63.68 | |
Midlands
| Professional | $63.68 | $63.68 | $63.68 |