| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $210.25 | $210.25 | $210.25 | |
Medica
| Professional | $467.11 | $467.11 | $467.11 | |
Midlands
| Facility | $138.28 | $138.28 | $153.74 | |
Midlands
| Professional | $116.07 | $138.28 | $190.80 |