| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.89 | $4,903.56 | $19,023.00 | |
Aetna
| Facility | 50 | $0.89 | $0.89 | $0.89 |
BCBS
| Facility | $64,999.99 | $77,999.99 | $94,999.99 | |
Cigna
| Facility | $334.93 | $334.93 | $334.93 | |
Providence
| Facility | $186.51 | $227.89 | $438.08 |