| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $419.26 | $699.21 | $699.21 |
Domicil/Rest Home New Pt Visit Hi Sever 60 Min
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $419.26 | $699.21 | $699.21 |