| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $313.50 | $535.26 | $535.26 |
Domicil/Rest Home New Pt Hi-Mod Sever 45 Minutes
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $313.50 | $535.26 | $535.26 |