| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $788.70 | $788.70 | $788.70 | |
Medica
| Professional | $874.90 | $874.90 | $874.90 | |
Midlands
| Facility | $490.10 | $490.10 | $490.10 | |
Midlands
| Professional | $490.10 | $543.54 | $832.26 |