| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $239.44 | $413.70 | $413.70 |
Indiv Phys Supvj Home/Dom/R-Home Mo 30 Min/>
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $239.44 | $413.70 | $413.70 |