| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $55.00 | $316.83 | $1,300.00 | |
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 | $55.00 | $316.83 | $1,300.00 | |
Medica
| Professional | $2,154.00 | $2,154.00 | $2,154.00 |