| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $169.10 | $169.10 | $184.41 | |
Medica
| Professional | $360.57 | $360.57 | $360.57 | |
Midlands
| Facility | $100.83 | $100.83 | $108.26 | |
Midlands
| Professional | $84.62 | $100.83 | $137.53 |