| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $42.90 | $61.97 | $106.95 | |
Medica
| Professional | $416.24 | $416.24 | $416.24 |
Mod Sed Diff Phys/Qhp<5 Yrs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $42.90 | $61.97 | $106.95 | |
Medica
| Professional | $416.24 | $416.24 | $416.24 |