| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $383.00 | $626.00 | $632.00 | |
Ambetter
| Facility | $151.16 | $231.26 | $231.26 | |
Medica
| Facility | $423.00 | $423.00 | $423.00 |
Behavioral Health Treatments/Services (also see 091X, an extension of 090X)-General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $383.00 | $626.00 | $632.00 | |
Ambetter
| Facility | $151.16 | $231.26 | $231.26 | |
Medica
| Facility | $423.00 | $423.00 | $423.00 |