| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $7,585.78 | $7,585.78 | $7,585.78 |
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $7,585.78 | $7,585.78 | $7,585.78 |