| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $90.00 | $90.00 | $90.00 | |
Medica
| Professional | $106.19 | $2,959.51 | $2,959.51 |
Medic-Health-Beh Asses/Interv
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $90.00 | $90.00 | $90.00 | |
Medica
| Professional | $106.19 | $2,959.51 | $2,959.51 |