| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $107.15 | $602.56 | $602.56 | |
Medica
| Professional | $154.88 | $154.88 | $154.88 |
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $107.15 | $602.56 | $602.56 | |
Medica
| Professional | $154.88 | $154.88 | $154.88 |