| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $4,897.79 | $4,897.79 | $4,897.79 | |
Medica
| Facility | AS | $489.78 | $489.78 | $489.78 |
Midlands
| Professional | $2,137.96 | $2,691.53 | $2,691.53 | |
United
| Facility | $2,187.76 | $3,630.78 | $5,888.44 |