| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $165.00 | $210.00 | $210.00 |
Professional Fees (see also 097X and 098X)-Psychiatric
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $165.00 | $210.00 | $210.00 |