| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $63,100.60 | $63,100.60 | $63,100.60 | |
Medica
| Professional | $2,443.12 | $2,443.12 | $2,443.12 | |
Midlands
| Facility | $624.94 | $624.94 | $624.94 | |
Midlands
| Professional | $624.94 | $624.94 | $624.94 |