| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $8,572.20 | $8,572.20 | $8,572.20 |
Other Therapeutic Services (see also 095X, an extension of 094X)-Other Therapeutic Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $8,572.20 | $8,572.20 | $8,572.20 |