| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $202.23 | $262.89 | $554.84 | |
Medica
| Professional | $2,154.00 | $2,154.00 | $2,154.00 |
Plmt Xtn Prosth Evasc Rpr Arysm/Dsj Ea Vsl
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $202.23 | $262.89 | $554.84 | |
Medica
| Professional | $2,154.00 | $2,154.00 | $2,154.00 |