| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $200.00 | $212.00 | $220.00 | |
Christus
| Facility | $12.00 | $19.00 | $55.00 | |
Lucent Health
| Facility | $66.00 | $66.00 | $66.00 |
Other Therapeutic Services (also See 095X, an extension of 094X) - Complex Medical Equipment Routine
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $200.00 | $212.00 | $220.00 | |
Christus
| Facility | $12.00 | $19.00 | $55.00 | |
Lucent Health
| Facility | $66.00 | $66.00 | $66.00 |