| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $147.00 | $147.00 | $147.00 |
Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-Activity Therapy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $147.00 | $147.00 | $147.00 |