| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $118.50 | $195.00 | $315.00 |
Other Therapeutic Services (see also 095X, an extension of 094X)-Complex Medical Equipment-Routine
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $118.50 | $195.00 | $315.00 |