| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $135.61 | $135.61 | $135.61 | |
Medica
| Professional | $231.53 | $231.53 | $231.53 |
Prog Eval Inper Leadls Pm
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $135.61 | $135.61 | $135.61 | |
Medica
| Professional | $231.53 | $231.53 | $231.53 |