| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $79.62 | $79.62 | $80.28 |
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 |
|---|---|---|---|---|---|
Medica
| Facility | $79.62 | $79.62 | $80.28 |