| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $229.09 | $776.25 | $776.25 | |
Medica
| Professional | $2,089.30 | $2,089.30 | $2,089.30 |
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $229.09 | $776.25 | $776.25 | |
Medica
| Professional | $2,089.30 | $2,089.30 | $2,089.30 |