| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $313.95 | $313.95 | $4,406.24 |
Medical/Surgical Supplies and Devices-Prosthetic/Orthotic Devices
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $313.95 | $313.95 | $4,406.24 |