| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $95.00 | $95.00 | $95.00 | |
Medica
| Professional | $1.67 | $4.17 | $4.17 | |
Midlands
| Facility | $0.90 | $464.38 | $464.38 | |
Midlands
| Professional | $464.38 | $464.38 | $464.38 | |
United
| Professional | $1.67 | $4.17 | $4.17 |