| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $200.70 | $200.70 | $210.62 |
Medical/Surgical Supplies and Devices - Other Supplies/Devices
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $200.70 | $200.70 | $210.62 |