| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $619.00 | $619.00 | $619.00 | |
Aetna
| Professional | $210.00 | $210.00 | $210.00 | |
Medica
| Facility | $210.00 | $210.00 | $210.00 |
Unlisted psychiatric service or procedure
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $619.00 | $619.00 | $619.00 | |
Aetna
| Professional | $210.00 | $210.00 | $210.00 | |
Medica
| Facility | $210.00 | $210.00 | $210.00 |