| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $4.00 | $4.00 | $4.00 | |
Capital Blue Cross
| Facility | $5,000.00 | $8,639.91 | $79,506.39 | |
Capital Blue Cross
| Professional | $91.80 | $108.00 | $108.00 | |
Cigna
| Professional | $7.62 | $7.62 | $7.62 | |
Priority Health
| Professional | $7.62 | $7.62 | $7.62 |