| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $4,000.00 | $4,000.00 | $4,000.00 |
Leave Of Absence - Icf/Mr - Any Reason
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $4,000.00 | $4,000.00 | $4,000.00 |