| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $277.10 | $277.10 | $332.51 | |
Medica
| Professional | $668.85 | $668.85 | $668.85 |
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $277.10 | $277.10 | $332.51 | |
Medica
| Professional | $668.85 | $668.85 | $668.85 |