| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $6,309.57 | $6,309.57 | $6,309.57 | |
Medica
| Facility | AS | $630.96 | $630.96 | $630.96 |
Midlands
| Professional | $2,754.23 | $3,388.44 | $3,388.44 | |
United
| Facility | $5,248.07 | $7,079.46 | $7,585.78 |