| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $1,165.00 | $3,243.00 | $13,785.00 |
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $1,165.00 | $3,243.00 | $13,785.00 |