| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Professional | $10.96 | $10.96 | $10.96 | |
Horizon BCBS
| Facility | $134.90 | $9,332.54 | $25,703.96 | |
Horizon BCBS
| Professional | $141.25 | $141.25 | $141.25 | |
United
| Facility | $67.61 | $141.25 | $295.12 | |
United
| Professional | $60.26 | $85.11 | $173.78 |