| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $97.52 | $97.52 | $97.52 | |
Midlands
| Professional | $94.28 | $94.28 | $94.28 | |
Wellmark
| Professional | $78.50 | $78.50 | $78.50 |
Unspecified Restorative Procedure, By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $97.52 | $97.52 | $97.52 | |
Midlands
| Professional | $94.28 | $94.28 | $94.28 | |
Wellmark
| Professional | $78.50 | $78.50 | $78.50 |