| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $85.00 | $85.00 | $85.00 | |
Medica
| Professional | $586.87 | $586.87 | $586.87 |
Sin Ndsc Plmt Drg Elut Mplnt
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $85.00 | $85.00 | $85.00 | |
Medica
| Professional | $586.87 | $586.87 | $586.87 |