| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $10.08 | $43.93 | $262.56 |
Medical/Surgical Supplies and Devices - Non Sterile Supply
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $10.08 | $43.93 | $262.56 |