| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $35.00 | $104.00 | $3,395.00 |
Anes 2/3 Dgr Brn Exc/Dbrdmt W/Wo Grf Ea 9% Tbs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $35.00 | $104.00 | $3,395.00 |