| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $106.30 | $606.90 | $606.90 | |
Medica
| Professional | $154.50 | $154.50 | $154.50 |
Puraply, puraply antimic
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $106.30 | $606.90 | $606.90 | |
Medica
| Professional | $154.50 | $154.50 | $154.50 |