| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $90.00 | $90.00 | $90.00 | |
Medica
| Professional | $335.78 | $335.78 | $335.78 | |
Midlands
| Facility | $80.94 | $80.94 | $80.94 | |
Midlands
| Professional | $80.94 | $80.94 | $80.94 | |
United
| Facility | $40.54 | $40.54 | $40.54 |