| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $471.00 | $471.00 | $471.00 | |
BCBS
| Facility | $1,860.00 | $2,146.00 | $3,929.00 | |
Cigna
| Facility | $3,262.09 | $565,822.61 | $3,427,200.00 |
Pharmacy-Extension of 025X and 063X - Reserved (Use 0250 for general c
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $471.00 | $471.00 | $471.00 | |
BCBS
| Facility | $1,860.00 | $2,146.00 | $3,929.00 | |
Cigna
| Facility | $3,262.09 | $565,822.61 | $3,427,200.00 |
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