| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $363.92 | $600.00 | $600.00 | |
Aetna
| Facility | 25 | $351.60 | $351.60 | $351.60 |
BCBS
| Facility | $284.92 | $284.92 | $284.92 | |
Cigna
| Facility | $116.73 | $116.73 | $601.34 |
Emergency Department Visit May Not Req Phys/Qhp
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $363.92 | $600.00 | $600.00 | |
Aetna
| Facility | 25 | $351.60 | $351.60 | $351.60 |
BCBS
| Facility | $284.92 | $284.92 | $284.92 | |
Cigna
| Facility | $116.73 | $116.73 | $601.34 |