| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $878.82 | $878.82 | $303,210.84 | |
Medica
| Professional | $878.82 | $3,433.59 | $3,433.59 | |
Midlands
| Facility | $878.82 | $878.82 | $878.82 | |
Midlands
| Professional | $878.82 | $878.82 | $878.82 |