| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $344.23 | $344.23 | $407.44 | |
Medica
| Professional | $796.67 | $796.67 | $796.67 | |
Midlands
| Facility | $259.33 | $259.33 | $280.77 | |
Midlands
| Professional | $217.66 | $259.33 | $353.90 |