| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $38.40 | $38.40 | $38.40 |
Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $38.40 | $38.40 | $38.40 |