| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $2,197.36 | $2,197.36 | $2,197.36 | |
Medica
| Professional | $2,197.36 | $2,197.36 | $2,197.36 | |
Midlands
| Professional | $692.90 | $1,154.83 | $1,526.99 |