| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $151.36 | $151.36 | $151.36 | |
Medica
| Facility | $812.83 | $812.83 | $10,715.19 | |
Medica
| Professional | $812.83 | $3,162.28 | $3,162.28 | |
Midlands
| Professional | $812.83 | $812.83 | $812.83 |