| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,737.80 | $6,165.95 | $10,471.29 | |
Aetna
| Facility | 50 | $2,089.30 | $5,888.44 | $9,549.93 |
Horizon BCBS
| Facility | $14,791.08 | $22,908.68 | $36,307.81 | |
United
| Facility | $4,570.88 | $9,120.11 | $21,379.62 |