| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $554.00 | $554.00 | $554.00 | |
Medica
| Facility | $1,917.00 | $1,917.00 | $1,917.00 |
Behavioral Health Treatments/Services Extension of 090X-Other Behavioral Health Treatments/Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $554.00 | $554.00 | $554.00 | |
Medica
| Facility | $1,917.00 | $1,917.00 | $1,917.00 |