| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $108.00 | $108.00 | $108.00 |
Professional Fees (Extension of 096X)-Physical Therapy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $108.00 | $108.00 | $108.00 |