| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $169.74 | $169.74 | $169.74 | |
Medica
| Professional | $98.00 | $356.22 | $356.22 | |
Midlands
| Facility | $117.00 | $117.00 | $117.00 | |
Midlands
| Professional | $87.09 | $116.14 | $149.56 | |
United
| Professional | $94.77 | $94.77 | $99.00 |