| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $175.09 | $212.16 | $212.16 | |
Medica
| Professional | $299.36 | $299.36 | $299.36 | |
Midlands
| Facility | $143.63 | $143.63 | $143.63 | |
Midlands
| Professional | $107.74 | $114.75 | $177.16 |