| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $74.34 | $74.34 | $164.01 | |
Medica
| Professional | $1,613.12 | $1,613.12 | $1,613.12 |
Unlisted Diagnostic Radiographic Procedure
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $74.34 | $74.34 | $164.01 | |
Medica
| Professional | $1,613.12 | $1,613.12 | $1,613.12 |