| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $255.00 | $255.00 | $255.00 | |
BCBS
| Facility | $47,000.00 | $81,499.99 | $94,999.99 | |
Cigna
| Facility | $794.48 | $794.48 | $794.48 | |
Providence
| Facility | $394.49 | $493.11 | $794.48 |