| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $170.13 | $170.13 | $294.30 |
Indiv Phys Supvj Home/Dom/R-Home Mo 15-29 Min
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $170.13 | $170.13 | $294.30 |