| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $13,880.20 | $13,880.20 | $13,880.20 | |
Medica
| Professional | $2,992.99 | $2,992.99 | $2,992.99 | |
Midlands
| Facility | $867.51 | $867.51 | $867.51 | |
Midlands
| Professional | $867.51 | $867.51 | $867.51 |