| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $10,460.00 | $10,460.00 | $10,460.00 |
Operating Room Services - Other Operating Room Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $10,460.00 | $10,460.00 | $10,460.00 |