| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $5,117.00 | $5,117.00 | $5,117.00 |
Other Therapeutic Services (see also 095X, an extension of 094X)-Complex Medical Equipment-Ancillary
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $5,117.00 | $5,117.00 | $5,117.00 |